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Class Action: Type 2 Pills Update. Diabetes Forecast. 59(1): RG10-RG13. January 2006.

This section on diabetes pills is from a special issue of Diabetes Forecast that offers the annual guide to diabetes products and services. This section reviews the five classes of diabetes pills and the combination oral medications that are now available. The author first reviews the normal physiology of the pancreas, insulin, and blood glucose levels, then describes what happens in type 2 diabetes. Many people benefit from taking two or more diabetes drugs, each of which addresses a different problem. Such combination therapy is so common that some drug companies now market combination pills. The remainder of the article consists of a detailed chart summarizing oral agents for type 2 diabetes, including the class of drug, the generic name, the brand name, and comments or cautions for the use of the drug. One figure depicts how and where each of these drugs works in the body. 1 figure. 1 table.

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Control Your Glucose, Control Diabetes Complications. Diabetes Health Monitor. 11(4): 15. July 2006.

This brief newsletter article reminds readers with diabetes of the importance of tight blood glucose (glycemic) control. The fact sheet covers the monitoring tests used for blood glucose (HbA1c or glycosylated hemoglobin, a measurement of blood glucose levels over time), microvascular complications, macrovascular complications, and strategies for achieving tight blood glucose control. For people with type 1 diabetes, tight glycemic control usually requires three or more daily injections of insulin or continuous treatment using an insulin pump. For people with type 2 diabetes, treatment usually involves lifestyle changes (diet and exercise) for 3 to 6 months, then adding oral medications, stepping up treatment whenever the previous regimen fails to be effective. One sidebar notes a recent finding that links increased consumption of red meat and whole milk products with insulin resistance. 1 figure.

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Diabetes in Clinical Practice: Questions And Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. 467 p.

This book deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. The book offers 30 chapters, beginning with an introduction to diabetes and followed by topics including the pathophysiology of type 1 and type 2 diabetes, glycemic control, hypoglycemic, diabetic coma, surgery in diabetes, acute illness in diabetes, diabetes and exercise, diabetes and pregnancy, diabetes and the young, diabetes and old age, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, microangiopathy in diabetes, diabetic foot, skin disorders in diabetes, sexual function in diabetes, musculoskeletal system and diabetes, infections in diabetes, hypertension and diabetes, lipids and diabetes, diabetes and driving, diabetes and travel, nutrition, oral medications, insulin, new therapies, and the prevention of diabetes. Each chapter presents three to six case studies, which are individually discussed, and relevant questions are posed and answered. Each chapter concludes with a list of references for further reading. Some chapters are illustrated with black-and-white photographs. A detailed subject index concludes the text.

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Diabetes Pills. Diabetes Health Monitor. 11(2): 16. March-April 2006.

This article, from a patient education publication, brings readers up-to-date on the oral medications that may be used as part of a management program for type 2 diabetes. The author describes five different classes of oral diabetes medications that are available in the United States: biguanides (metformin), sulfonylureas, non-sulfonylurea secretagogues (the meglitinides), thiazolidinediones, and alpha-glucosidase inhibitors. The author briefly explains how each class of drugs works, possible side effects, and when the drugs might be prescribed. The article stresses that no one drug is best, but each group of drugs may be used to address different issues at different stages of the disease.

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Erectile Dysfunction. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 363-376.

This chapter on erectile dysfunction (ED) is from a comprehensive text on obesity and diabetes. ED is defined as the consistent or recurrent inability to attain or maintain a penile erection sufficient for sexual intercourse. ED is a common sexual dysfunction, especially among men with diabetes. Diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease are known to increase the likelihood of having ED. The author discusses a definition and epidemiology of ED, its pathophysiology, the diagnostic evaluation, treatment options, and the costs of various treatments. Vascular impairment in diabetes will lead to ED from large-vessel disease, but more important, from problems with intrapenile blood flow. Diagnostic components should include the patient's history, a physical examination, and diagnostic testing, including tests that measure nocturnal penile activity and patient symptom surveys. Treatment options include optimizing glycemic control, oral medications, injectable therapy, transurethral therapy, vacuum assistance devices, constriction rings, and penile implants. 1 figure. 5 tables. 35 references.

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Exenatide: From Gila Monster to You. Diabetes Self-Management. 23(1): 36-40. January-February 2006.

This article familiarizes readers with exenatide, the first of a new class of drugs called incretin mimetics. These substances enhance insulin secretion in response to elevated blood glucose levels. Exenatide also suppresses secretion of glucagon (a hormone that raises blood glucose levels) and slows the emptying of the stomach, both of which help improve blood glucose regulation. The author reviews the research that led to the drug's development and marketing, as well as its use in people with type 2 diabetes, how exenatide works in tandem with other oral medications to stabilize blood glucose levels, injection aids (including a prefilled injector pen that holds a 30-day supply of the drug), and how exenatide is similar to and differs from another new diabetes drug, pramlintide. Exenatide is currently approved for use only in people with type 2 diabetes, and only in those who take one or both of two oral medications (metformin and one of the sulfonylureas). It is not approved for use in people who use insulin, but is presently being studied with this use in mind. The author concludes by briefly reviewing other incretin mimetics currently under development. One sidebar offers some basic information about the Gila monster (Heloderma suspectum), the animal from which exenatide was first synthesized.

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First Inhaled Insulin Product Approved. FDA Consumer. 40(2): 28-29. March- April 2006.

This article reports on the recent approval (January 2006) of Exubera, a powdered form of human insulin that is inhaled into the lungs through the patient’s mouth using a specially designed inhaler. The author briefly reviews the different major types of diabetes, then outlines the research studies that resulted in the approval of Exubera. Peak insulin levels were achieved in about 50 minutes, range 30 minutes to 90 minutes, with Exubera inhaled insulin compared with 105 minutes, range 60 to 240 minutes, with regular insulin. In type 1 diabetes, inhaled insulin may be added to longer-acting insulins as a replacement for short-acting insulin taken with meals. In type 2 diabetes, inhaled insulin may be used alone, along with oral medications that control blood sugar, or with longer-acting insulins. As with other insulin products, hypoglycemia is a side effect of Exubera, and patients need to monitor their blood glucose levels regularly. Exubera is not for patients who smoke or those who have quit smoking within the previous six months; baseline tests for lung function are recommended before beginning treatment. 1 figure.

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Manufacturers and Exclusive Distributors. Diabetes Forecast. 59(1): RG67-RG69. January 2006.

This manufacturer's guide is from a special section of Diabetes Forecast that presents an annual guide to diabetes products and services. The guide lists items in seven categories: new diabetes products, type 2 oral medications, insulin, insulin delivery, blood glucose meters and data management systems, products for treating low blood glucose, and urine testing. Specific products include human and analog insulin, syringes, injection aids, insulin pens and pen needles, insulin pumps, aids for people who are visually and physically impaired, pairing the blood glucose meter with software, blood-sampling supplies, meter supplies, glycohemoglobin tests, microalbuminuria testing kits, and over-the-counter products for meal replacement, blood glucose stabilization, and preventing low blood glucose. This final section lists the name, address, telephone number, and web site addresses of the manufacturers of the products and supplies listed in the guide.

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Nutritional Strategies in Pregestational, Gestational, and Postpartum Diabetic Patients. IN: Mechanick, J.; Brett, E., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 133-148.

This chapter on nutritional strategies in pregestational, gestational, and postpartum diabetic patients is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The authors note that medical nutrition therapy (MNT) is now focused on providing adequate calories, nutrients, minerals, and vitamins to maintain a healthy pregnancy while keeping glucose levels as close to normal as possible. The chapter discusses pregestational diabetes and prepregnancy planning; oral medications and insulin; prepregnancy assessment of diabetes-related medical conditions, including retinopathy, renal function, and heart disease; gestational diabetes mellitus and its screening; diets designed to minimize postprandial hyperglycemia for the pregnant diabetic woman; proper weight gain; the role of exercise; insulin therapy; and postpartum care. 6 tables. 57 references.

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Products for Treating Low Blood Glucose. Diabetes Forecast. 59(1): RG60-RG62. January 2006.

For people with diabetes, a drop in blood glucose can occur when they take too much insulin or oral medications; eat too little food or inadequate nutrients to cover their insulin or oral medication; do not eat at the appropriate time; or get more physical activity than they prepared for. This section on products for treating low blood glucose is from a special issue of Diabetes Forecast that offers the annual guide to diabetes products and services. The author first reviews the physiology of hypoglycemia (low blood glucose), including the symptoms, the causes, and suggestions for how to prevent and treat low blood glucose reactions. In addition to juice and other carbohydrates, there are commercially-manufactured products that are available to treat low blood glucose. The author reviews three points to consider when purchasing these products: how quickly it works, the form it comes in, and costs. Specific products described include ExtendBar that provides a continuous glucose supply for up to 9 hours; Glucerna Shakes, weight-loss shakes, meal, and snack bars, that contains carbohydrates that are digested slowly to help minimize peaks in blood glucose; and Enterex Diabetic Drink, which offers complete and balanced nutrition with no sugar added for meal replacement. One chart briefly summarizes the products described. 1 table.

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