This blog tracks updates to the Blood Sugar 101 Web site.


Saturday, November 14, 2015

New Page: The Real Symptoms of Diabetes

Page added: The Real Symptoms of Type 2 Diabetes

 Contrary to what you might read elsewhere, the actual symptoms that most people with Type 2 diabetes experience right before they are given a diabetes diagnosis are not increased thirst, a continual need to urinate, and unexplained weight loss.

These symptoms are typical of Type 1 diabetes. And they also occur in people with Type 2 Diabetes when their beta cells have become so damaged by years of exposure to very high blood sugars that they no longer can secrete any insulin. But nowadays most people are diagnosed with diabetes early enough that they have not experienced this kind of diabetic damage.

Neither do many people who are fully diabetic have several other diabetic symptoms you see listed on the American Diabetes Association's web site: slow healing of cuts and bruises, and pain and tingling in their hands and feet. These symptoms also are associated with long-standing diabetes, as they are the result of diabetic nerve damage, a diabetic complication that typically takes years to develop.

People with diabetes may experience three symptoms also listed on the ADA's list of diabetic symptoms in the months or year before diagnosis: blurry vision, extreme tiredness, and feeling very hungry though eating sufficient food. But so do many other people who don't have diabetes, since these symptoms can be produced by thyroid problems, allergies, or coming down with the flu. So these symptoms alone are not enough to suggest that a person has diabetes. Though if you do experience relentless hunger, which often produces the obesity so many doctors incorrectly believe causes diabetes, it is a very good idea to ask your doctor to test your blood sugar to ensure that in your case this relentless hunger is not a true symptom of diabetes or prediabetes.

That said, however, the most common symptom most people with Type 2 Diabetes experience is none at all! 

I have heard from quite a few people who were diagnosed with blood sugars well over 400 mg/dl (22 mmol/L) who had no idea anything was wrong until their doctor came in waving a lab test result sheet in their face.

The reason for this is that doctors are becoming better at diagnosing people with diabetes before they have had it for the many years it takes for diabetes to cause the severe damage to the pancreas and nerves that results in the first two groups of symptoms listed above. So people are getting diagnosed with diabetes long before they develop the symptoms of long-standing diabetic complications.

But that said, there are a few conditions that are not considered by most doctors to be symptoms of diabetes that often are.

The Lesser Known Symptoms of Early Diabetes

  1. Recurrent Urinary Tract and Genital Yeast infections.
    When you are diabetic, your body will eliminate the excess glucose from your blood by diverting it into your urine. Bacteria and yeast thrive on this urinary glucose. Though you may temporarily wipe them out with medications, they are likely to come right back, since there are always more yeast and bacteria in the environment to create new infections.

  2. Carpal Tunnel Syndrome.
    Studies have shown that Carpal tunnel syndrome often occurs as much as a decade before a person is diagnosed with diabetes, and that it may be predictive of it. Other tendon problems, like Tarsal Tunnel Syndrome and Frozen Shoulder (Adhesive Capsulitis) may also point to the presence of undiagnosed diabetes.

  3. Ruptured Vertebral Discs.
    While the evidence for this as a diabetic complication is less compelling than it is for the previously mentioned symptom, there is also some evidence that discs may rupture after years of exposure to higher than normal blood sugars. Apparently this exposure may make disc material become "crispy" and hence more likely to rupture. (Details HERE. Spinal stenosis has also been found to be associated with diabetes. (Details HERE. So if you have a family in which relatives have both diabetes and serious back troubles, a diagnosis of degenerative disc disease should motivate you to ask your doctor to check out your blood sugar.

  4. Sleepiness Shortly After Eating a Lot of Starch and Sugar.
    If your blood sugars are rising extremely high after you eat a high carbohydrate meal or dessert and then dropping down swiftly, you may often feel the sudden onset of exhaustion as your blood sugars drop. This symptom points to a very early diabetic state, however. If you don't take steps to lower your blood sugar when it is rising and falling this way, eventually it will just stay high and you will no longer experience the rapid drop that is so enervating.



If you develop any of these conditions, ask your doctor to include an A1c test and a fasting glucose test with your next lab test. If the tests come back normal, it doesn't hurt to test your blood sugar with a blood sugar meter at home as described HERE to make sure you aren't experiencing diabetic blood sugars after eating, since the tests doctors order often miss that kind of diabetic blood sugar. If you see post-meal blood sugars that are firmly in the diabetic range ask your doctor to order a Glucose Tolerance Test with readings taken 1 and 2 hours after consuming the glucose, as this is the test that can diagnose diabetes that only shows up after meals.

Is It Really Diabetes?

An surprising proportion of the email I receive from people who visit this site comes from people who by no stretch of the imagination have diabetes, though they do have a lot of painful, persistent, and at time bizarre symptoms that their doctors haven't been able to diagnose.

Many of these people are hoping that they do have diabetes, because they are so desperate to find some cause for their symptoms that can be treated and and give them relief. But before you assume that a symptom you are experiencing is due to undiagnosed diabetes use the technique described HERE to test your blood sugar. If you aren't seeing readings in the diabetic range, you don't have diabetes and you will not be able to convince any doctor to the contrary.

If you discover that you have blood sugars in the prediabetic range, or if your blood sugars are only in the diabetic range after eating, a condition that does not show up on most of the tests that doctors order, you can still do a lot on your own to lower those blood sugars back to a safe level. You'll find instructions on this page:

How to Lower Your Blood Sugar

Follow these instructions and bring your blood sugars down to a safe, normal range and you need never experience any of the symptoms of diabetes. Even if you have actually had diabetes.

Thursday, October 15, 2015

Afrezza Page Rewritten to Embody User Experience Since Product Release

Page Changed: Inhaled Insulin Please visit the link above to read the newly revised text, much of which has been changed from the previous version posted shortly after the drug was released.

Wednesday, October 14, 2015

New Page: The Real Symptoms of Diabetes

New Page added: The Real Symptoms of Diabetes

Text added:

Contrary to what you might read elsewhere, the actual symptoms that most people with Type 2 diabetes experience right before they are given a diabetes diagnosis are not increased thirst, a continual need to urinate, and unexplained weight loss.

These symptoms are typical of Type 1 diabetes. And they also occur in people with Type 2 Diabetes when their beta cells have become so damaged by years of exposure to very high blood sugars that they no longer can secrete any insulin. But nowadays most people are diagnosed with diabetes early enough that they have not experienced this kind of diabetic damage.

Neither do many people who are fully diabetic have several other diabetic symptoms you see listed on the American Diabetes Association's web site: slow healing of cuts and bruises, and pain and tingling in their hands and feet. These symptoms also are associated with long-standing diabetes, as they are the result of diabetic nerve damage, a diabetic complication that typically takes years to develop.

People with diabetes do experience three symptoms also listed on the ADA's list of diabetic symptoms in the months or year before diagnosis: blurry vision, extreme tiredness, and feeling very hungry though eating sufficient food. But so do many other people who don't have diabetes, since these symptoms can be produced by thyroid problems, allergies, or coming down with the flu. So these symptoms alone are not enough to suggest that a person has diabetes. Though if you do experience relentless hunger, which often produces the obesity so many doctors incorrectly believe causes diabetes, it is a very good idea to ask your doctor to test your blood sugar to ensure that in your case this relentless hunger is not a true symptom of diabetes or prediabetes.

That said, however, the most common symptom most people with Type 2 Diabetes experience is none at all! I have heard from quite a few people who were diagnosed with blood sugars well over 400 mg/dl (22 mmol/L) who had no idea anything was wrong until their doctor came in waving a lab test result sheet in their face.

The reason for this is that doctors are becoming better at diagnosing people with diabetes before they have had it for the many years it takes for diabetes to cause the severe damage to the pancreas and nerves that results in the first two groups of symptoms listed above. So people are getting diagnosed with diabetes long before they develop the symptoms of long-standing diabetic complications.

But that said, there are a few conditions that are not considered by most doctors to be symptoms of diabetes that often are.


The Lesser Known Symptoms of Early Diabetes

  1. Recurrent Urinary Tract and Genital Yeast infections.
    When you are diabetic, your body will eliminate the excess glucose from your blood by diverting it into your urine. Bacteria and yeast thrive on this urinary glucose. Though you may temporarily wipe them out with medications, they are likely to come right back, since there are always more yeast and bacteria in the environment to create new infections.




  2. Carpal Tunnel Syndrome.
    Studies have shown that Carpal tunnel syndrome often occurs as much as a decade before a person is diagnosed with diabetes, and that it may be predictive of it. Other tendon problems, like Tarsal Tunnel Syndrome and Frozen Shoulder (Adhesive Capsulitis) may also point to the presence of undiagnosed diabetes.




  3. Ruptured Vertebral Discs.
    While the evidence for this as a diabetic complication is less compelling than it is for the previously mentioned symptom, there is also some evidence that discs may rupture after years of exposure to higher than normal blood sugars. Apparently this exposure may make disc material become "crispy" and hence more likely to rupture. (Details HERE. Spinal stenosis has also been found to be associated with diabetes. (Details HERE. So if you have a family in which relatives have both diabetes and serious back troubles, a diagnosis of degenerative disc disease should motivate you to ask your doctor to check out your blood sugar.




  4. Sleepiness Shortly After Eating a Lot of Starch and Sugar.
    If your blood sugars are rising extremely high after you eat a high carbohydrate meal or dessert and then dropping down swiftly, you may often feel the sudden onset of exhaustion as your blood sugars drop. This symptom points to a very early diabetic state, however. If you don't take steps to lower your blood sugar when it is rising and falling this way, eventually it will just stay high and you will no longer experience the rapid drop that is so enervating.


  5. If you develop any of these conditions, ask your doctor to include an A1c test and a fasting glucose test with your next lab test. If the tests come back normal, it doesn't hurt to test your blood sugar with a blood sugar meter at home as described HERE to make sure you aren't experiencing diabetic blood sugars after eating, since the tests doctors order often miss that kind of diabetic blood sugar. If you see post-meal blood sugars that are firmly in the diabetic range ask your doctor to order a Glucose Tolerance Test with readings taken 1 and 2 hours after consuming the glucose, as this is the test that can diagnose diabetes that only shows up after meals.

    Is It Really Diabetes?
    An surprising proportion of the email I receive from people who visit this site comes from people who by no stretch of the imagination have diabetes, though they do have a lot of painful, persistent, and at time bizarre symptoms that their doctors haven't been able to diagnose.

    Many of these people are hoping that they do have diabetes, because they are so desperate to find some cause for their symptoms that can be treated and and give them relief. But before you assume that a symptom you are experiencing is due to undiagnosed diabetes use the technique described HERE to test your blood sugar. If you aren't seeing readings in the diabetic range, you don't have diabetes and you will not be able to convince any doctor to the contrary.

    If you discover that you have blood sugars in the prediabetic range, or if your blood sugars are only in the diabetic range after eating, a condition that does not show up on most of the tests that doctors order, you can still do a lot on your own to lower those blood sugars back to a safe level. You'll find instructions on this page:

    How to Lower Your Blood Sugar

    Follow these instructions and bring your blood sugars down to a safe, normal range and you need never experience any of the symptoms of diabetes. Even if you have actually had diabetes.

    Tuesday, September 29, 2015

    Added Link to Blog Post Examining Tresiba Label

    Page Changed: Insulin for Type 2 Diabetes

    Added the following:
    Tresiba, a longer acting insulin was approved in late September of 2015. Basaglar, a biosimilar version of Lantus will not be sold in the U.S. until 2017,
    You can learn more about the new basal insulins in these blog posts which go into the properties of each extensively:
    Toujeo, a More Concentrated Version of Lantus
    The Newly Approved Basal Insulin Tresiba's Label is Disappointing.

    Thursday, September 17, 2015

    FDA Links Invokana to Bone Fractures and Decreased Bone Mineral Density. Other Drugs in Class Suspect too.

    Page Changed: 

    SGLT2 Inhibitors, Farxiga, Invokana, Jardiance. Questionable New Drugs

    Text Added:

    Bone Fracture Risk and Decreased Bone Mineral Density

    On Sept 10, 2015, the FDA issued a Safety Alert for Invokana and Invokamet, stating that  "Bone fractures have been seen in patients taking the type 2 diabetes medicine canagliflozin [Invokana].Fractures can occur as early as 12 weeks after starting canagliflozin. Canagliflozin has also been linked to decreases in bone mineral density at the hip and lower spine." Though the warning specifically mentioned Invokana, the oldest drug in this class, the warning bulletin also said "FDA is ontinuing to evaluate the risk of bone fractures with other drugs in the SGLT2 inhibitor class, including dapagliflozin (Farxiga, Xigduo XR) and empaglifozin (Jardiance, Glyxambi, Synjardy), to determine if additional label changes or studies are needed."FDA:Invokana and Invokamet (canagliflozin): Drug Safety Communication - New Information on Bone Fracture Risk and Decreased Bone Mineral DensityNote that once your bones have become weakened, it is very hard or possibly impossible to rebuild them. This side effect probably occurs because messing with how the kidneys excrete glucose also affects how they handle the minerals used build bones: phosphorus, calcium, and magnesium. If your doctor prescribes one of these drugs, ask him or her if they are aware of these two recent FDA safety warnings. Chances are that they may have missed them.

    Tuesday, June 23, 2015

    New Basal Insulins Introduced

    Page changed: Insulin for Type 2 Diabetes

    Added text:
     In spring of 2015, a new basal insulin, Toujeo, was introduced. It is another version of the same insulin molecule found in Lantus, sold in a more concentrated form. Two other basal insulins. Tresiba and Basaglar have not yet hit the market in the U.S. though Tresiba is available in Europe and Basaglar has been approved for sale in 2016.  You can learn more about the new basal insulins HERE. ...

    The new basal insulins are being marketed with the claim that they last 24 hours and have an even flatter activity curve. However, given that all the well-known insulins can perform differently from what the marketing materials say they will, we will have to wait for a year or two until a significant number of users in the online diabetes community have reported on their results  to know know how true this is. The new basal insulins are also being marketed, where possible, with the claim that they are less likely to cause hypos. However, the FDA has refused to let Toujeo be marketed with this claim, though the European authorities allow it.

    ALSO: Deleted reference to concerns about enhanced cancer risk with Lantus as subsequent research seems to suggest this is not an issue.

    Tuesday, June 9, 2015

    A new high profile study that claims to show Januvia is completely safe, does not

    Page Changed: DPP-4 Inhibitors Januvia, Onglyza, Trajenta, Combiglyze, Janumet, and Jentadueto

    Text Added:

    A larger, more high profile study was published in the New England Journal of Medicine in June of 2015:Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. Jennifer B. Green, et al. NEJM, June 8, 2015DOI: 10.1056/NEJMoa1501352 Though the focus of the study was on cardiovascular outcomes, it was also reported as stating that there was no sign of more pancreatitis or pancreatic cancer in the group that took Januvia.

    Short Term Studies Can't Discover Potentially Fatal Cancers that Take A Decade to Be Detectable

    There are several reasons to refute the idea that these studies prove these drugs don't cause cancer. The first study only lasted 2 years, which is far too short a time for the changes in pancreatic architecture discovered by Dr. Butler to result in overt pancreatitis.  The study published in the New England Journal of Medicine study only lasted three years. But it would be quite possible to draw the same conclusion about the safety of smoking cigarettes if you limited your study to a three year period. Cancers of the pancreas take a long time to grow to where they are detectable, and by the time they are, they are almost always fatal. Pancreatic cancer is almost always symptom-free until it is too late for any treatment to keep the patient from dying within a few months.