By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
There are 4 different speeds of insulin available. I am going to call them really fast, fast, slow and really slow.
There are currently two really fast insulins. They are called Humalog and NovoRapid and are classified as Human insulin analogues. They can be given right with the meal because they go into the body so fast, they cause the sugar from the meal to get out of the blood and into the tissues right away. They start working in 15 to 30 minutes after injection. The peak effect is in about an hour and they are out of the body in 3 to 5 hours. The really fast insulins work so fast that the diabetic must eat during or right after injection or their blood sugar might go too low. The really fast insulins are often given 3 times a day with meals.
The fast insulin is just plain insulin. It goes by the name Humulin R or Novolin Toronto.
There are also insulin pumps. These are expensive (in the thousands of dollars), they require a lot of training at first to learn how to use properly, but they are very interesting. Your pancreas releases a small amount of insulin into your body all the time (called basal insulin), and a pulse when you eat sugar (an insulin peak). Let’s say Jane is using an insulin pen and she uses short acting insulin at meal times (insulin peaks when they eat) and a long acting insulin at bedtime (this mimics the basal insulin). ( There are other ways of giving insulin. This was just an example. Don’t panic if you doctor has you doing something different.) So Jane’s injections are close to how a pancreas works but not exactly. With an insulin pump, the pump would release a small amount of short acting insulin all the time (basal insulin) and Jane could program the pump to release a pulse of insulin based on what she eats (an insulin peak). So insulin pumps more closely mimic what a pancreas does. They aren’t perfect, though. Jane would still have to poke her finger many times a day to check her sugar, and would have to become quite knowledgeable about how to use her pump in case of problems, clogs, etc.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Tuesday, March 14, 2006
Tuesday, February 21, 2006
INSULIN FAST OR SLOW Part 1
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
What is diabetes? Good question. Well if you look way back you get the quote by Aretaeus the Cappadocian in the second century AD when he called diabetes as “being a melting down of the flesh and limbs into urine.” It is not really accurate, but very dramatic. Or you can go to the Latin origins of the word. If you look at the words diabetes mellitus (the full latin name), you can paraphrase it to mean “sweet tasting urine”. It was literally diagnosed by “water tasters” who drank the urine of those suspected of having diabetes; the urine of people with diabetes was thought to be sweet-tasting. The Latin word for honey (referring to its sweetness), 'mellitus', is added to the term diabetes as a result. Doctors today should be very happy they have lab tests to use
These answers were not leading me anywhere, so I started where many people start, I Googled “diabetes”. The second site listed was www.diabetes.ca and that is the web site of the Canadian Diabetes Association. A few more clicks and I found that diabetes is when your body has trouble storing and using glucose. Glucose is a simple sugar that fuels many processes in the body. There are 3 types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is when your pancreas doesn’t produce insulin. You must inject insulin or you will die. In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin. However, other parts of the body like your muscle and fat cells aren’t listening to the insulin signal. That means tissues like muscle and fat don’t suck the glucose out of the blood and use it. Type 2 diabetes can be treated with diet, exercise, pills or insulin, or often a combination of these. Gestational diabetes only occurs in pregnancy.
Canadians have a proud history in the treatment of diabetes. Fredrick Banting and Charles Best who found a substance called insulin inside the pancreas’s of dogs that stopped people from dying from a strange wasting disease called diabetes. More recently, in 1999 Dr. James Shapiro and his team at the University of Alberta developed “The Edmonton Protocol”. They found a way to transplant the insulin producing cells from a person’s pancreas into the diabetic’s liver. Researchers had tried for more than 20 years to successfully transplant the cells that produce insulin from a healthy pancreas into the body of a person with diabetes. Yet of 405 attempts since 1970, 92 per cent of the recipients were back on insulin within a year. Dr. Shapiro and his team figured out the proper procedure and proper mix of anti-rejection drug and were successful. (See Canadians can be pretty smart, eh?)
What do Banting and Shapiro’s work have in common? Ways of getting insuling into diabetics. There are many types of insulin. The simplest is called R or Toronto insulin (Did I mention Banting and Best worked out of the University of Toronto?). It is produced by microbes that have a tiny bit of human DNA implanted in them and is identical to the insulin that the human body produces (and you thought genetic engineering was in the future) It is a short acting insulin. There are faster acting insulin in which the insulin molecule is changed a little to make it work faster. Other insulins with names like N, L and U are slow acting. They take R insulin and put it in a solution with other stuff to make the insulin release slowly. Insulin has to be injected because if it is taken orally, the stomach acid will destroy it.
Most people think of small syringes when they think of insulin. There also are insulin pens. Pens still have a needle, but many people find the fact you “dial up” the dose, instead of drawing up insulin into the syringe makes them easier to use. The pen needles also tend to be finer (in case you were interested, the finer the needle the bigger the gauge number) and shorter. Because of this, many people find the insulin pens more comfortable. The insulin pens give an audible “click” on each unit of insulin they dial up, so even those with visual impairments can use the insulin pens. Using a syringe with a visual impairment can be difficult.
Next time we will talk about how really fast and really slow insulins can be used to try to mimic the pancreas.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
What is diabetes? Good question. Well if you look way back you get the quote by Aretaeus the Cappadocian in the second century AD when he called diabetes as “being a melting down of the flesh and limbs into urine.” It is not really accurate, but very dramatic. Or you can go to the Latin origins of the word. If you look at the words diabetes mellitus (the full latin name), you can paraphrase it to mean “sweet tasting urine”. It was literally diagnosed by “water tasters” who drank the urine of those suspected of having diabetes; the urine of people with diabetes was thought to be sweet-tasting. The Latin word for honey (referring to its sweetness), 'mellitus', is added to the term diabetes as a result. Doctors today should be very happy they have lab tests to use
These answers were not leading me anywhere, so I started where many people start, I Googled “diabetes”. The second site listed was www.diabetes.ca and that is the web site of the Canadian Diabetes Association. A few more clicks and I found that diabetes is when your body has trouble storing and using glucose. Glucose is a simple sugar that fuels many processes in the body. There are 3 types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is when your pancreas doesn’t produce insulin. You must inject insulin or you will die. In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin. However, other parts of the body like your muscle and fat cells aren’t listening to the insulin signal. That means tissues like muscle and fat don’t suck the glucose out of the blood and use it. Type 2 diabetes can be treated with diet, exercise, pills or insulin, or often a combination of these. Gestational diabetes only occurs in pregnancy.
Canadians have a proud history in the treatment of diabetes. Fredrick Banting and Charles Best who found a substance called insulin inside the pancreas’s of dogs that stopped people from dying from a strange wasting disease called diabetes. More recently, in 1999 Dr. James Shapiro and his team at the University of Alberta developed “The Edmonton Protocol”. They found a way to transplant the insulin producing cells from a person’s pancreas into the diabetic’s liver. Researchers had tried for more than 20 years to successfully transplant the cells that produce insulin from a healthy pancreas into the body of a person with diabetes. Yet of 405 attempts since 1970, 92 per cent of the recipients were back on insulin within a year. Dr. Shapiro and his team figured out the proper procedure and proper mix of anti-rejection drug and were successful. (See Canadians can be pretty smart, eh?)
What do Banting and Shapiro’s work have in common? Ways of getting insuling into diabetics. There are many types of insulin. The simplest is called R or Toronto insulin (Did I mention Banting and Best worked out of the University of Toronto?). It is produced by microbes that have a tiny bit of human DNA implanted in them and is identical to the insulin that the human body produces (and you thought genetic engineering was in the future) It is a short acting insulin. There are faster acting insulin in which the insulin molecule is changed a little to make it work faster. Other insulins with names like N, L and U are slow acting. They take R insulin and put it in a solution with other stuff to make the insulin release slowly. Insulin has to be injected because if it is taken orally, the stomach acid will destroy it.
Most people think of small syringes when they think of insulin. There also are insulin pens. Pens still have a needle, but many people find the fact you “dial up” the dose, instead of drawing up insulin into the syringe makes them easier to use. The pen needles also tend to be finer (in case you were interested, the finer the needle the bigger the gauge number) and shorter. Because of this, many people find the insulin pens more comfortable. The insulin pens give an audible “click” on each unit of insulin they dial up, so even those with visual impairments can use the insulin pens. Using a syringe with a visual impairment can be difficult.
Next time we will talk about how really fast and really slow insulins can be used to try to mimic the pancreas.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Monday, February 13, 2006
ARTIFICIAL SWEETNERS
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit http://www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health professional.
A few months ago a friend sent me an email warning of the dangers of aspartame (Nutrasweet). I sent one back saying aspartame was safe especially in diabetics. Kevin Thiele, local dietician and diabetes educator, gave an excellent talk a couple of weeks ago on carbohydrate counting and label reading. Several of the pharmacists from the Dauphin Clinic Pharmacy went and we learned a lot. There were questions from the crowd about aspartame during the talk. “Is it true that aspartame causes Multiple Sclerosis?” “Isn’t aspartame a poison?” Kevin handled the questions very well, but I thought artificial sweetners would make a good article topic.
The straight forward answer to diabetics about artificial sweetners is that they are a good alternative to sugar as a sweetner. To use my new found knowledge from Kevin Thiele’s talk, I scavenged the pharmacy staff fridge and found a no-name can of cola. In 355 mL it contains 42 g of carbohydrate, which is worth 3 CARB Choices. A person needs at least 9 CARB Choices per day and that should be spread over 3 meals. Kevin said a female diabetic should aim for 3-4 CARB Choices per meal and a male diabetic should aim for 4-5 CARB Choices per meal. So if a female diabetic decided she wanted a can of cola, that would use up all her CARB Choices for one meal and she would need to choose things without carbohydrates in them like a salad and chicken breast for that meal. Now if that same female diabetic craves 5-6 cans of cola per day, that would put her at 16 CARB Choices and that puts her way over budget no matter what she eats. So if she replaces regular cola with artificially sweetened cola she will be much better off.
The four common artificial sweetners are: aspartame (Equal, Nutrasweet), saccharin (Sweet ‘N Low), acesulfame (Sunette), and sucralose (Splenda). They have been blamed for everything from cancer to seizures to Multiple Sclerosis to chronic fatigue. There is no good evidence that they cause any of these. We will talk about the top two saccharin and aspartame.
Saccharin has been around for more than a century. It is 300 times sweeter than sugar. This means if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.14 grams of saccharin to sweeten it. Since so little saccharin sweetens so much stuff it was used a lot in the two World Wars because sugar was scarce. In the 1970’s the Food and Drug Administration in the US started looking at saccharin safety. Initially it was found that huge doses of saccharin (way more per body weight than people would eat) caused bladder cancer in rats. Since then, the data has been reviewed and saccharin is now considered safe. The National Cancer Institute, the National Toxicology Program, the American Diabetes Association, American Dietetic Association, American Cancer Society, and American Medical Association all support the use of saccharin and say it is safe.
Aspartame has been available in Canada since 1981. It is about 200 times sweeter than sugar. So if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.21 grams of aspartame to sweeten it. As a side note, have you ever noticed that diet soft drinks foam or froth or bubble much more that regular sugared ones? That is because you need so much more sugar to sweeten it than aspartame, the sugared soft drinks are more viscous and thus foam less. Aspartame has been accused of causing everything from seizures to cancer to hair loss. None of these claims has ever been proven in a clinical trial. Many of the claims of damage I have heard about aspartame are because as aspartame is being broken down in the body, formaldehyde is produced. Formaldehyde is a poison, so aspartame must be a poison, right? Wrong. Many fruits and vegetables break down into small amounts of formaldehyde as well. This formaldehyde will break down into formic acid and then to water and carbon dioxide. Want further proof your body can handle small amounts of formaldehyde? That last hang over you had was due in part to formaldehyde. Ethyl alcohol changes in part into formaldehyde. Some of the pain of the hang over was due to too much formaldehyde in your body. But your body eventually metabolized it and the hang over went away. You get much more formaldehyde in your body from a hang over than from aspartame.
In general aspartame has been thoroughly tested by the Canadian and American authorities and found to be safe. There is one group that must avoid aspartame. This condition is called phenylketonuria or PKU, a disorder of amino acid metabolism. Accumulation of phenylalanine can lead to neurological, behavioral and dermatologic problems in this population. Since aspartame contains phenylalanine, patients with PKU should not use aspartame.
So I have already said I think artificial sweetners are a good option for diabetics. Should non-diabetics use them? In moderation, saccharine, aspartame, acesulfame potassium and sucralose appear to be safe. The FDA in the US and Health Canada have set acceptable daily limits of these sweetners and studies show that normal diets contain far less sweetners than these limits. So yes, in moderation, these sweetners are safe to use. Do I use them? Yes I do. One last word about moderation, though. Almost anything can be toxic if used too much. A condition called water toxicity can happen if you drink too much water. I bring this up because one of the clinic physicians was talking about a patient of theirs that drank 8-12 liters of diet soft drinks per day. This patient didn’t mention this diet related quirk to their physician for years. When the patient’s enormous diet soft drink consumption finally came out, the doctor could finally successfully cure the patient’s chronic diarrhea.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit http://www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health professional.
A few months ago a friend sent me an email warning of the dangers of aspartame (Nutrasweet). I sent one back saying aspartame was safe especially in diabetics. Kevin Thiele, local dietician and diabetes educator, gave an excellent talk a couple of weeks ago on carbohydrate counting and label reading. Several of the pharmacists from the Dauphin Clinic Pharmacy went and we learned a lot. There were questions from the crowd about aspartame during the talk. “Is it true that aspartame causes Multiple Sclerosis?” “Isn’t aspartame a poison?” Kevin handled the questions very well, but I thought artificial sweetners would make a good article topic.
The straight forward answer to diabetics about artificial sweetners is that they are a good alternative to sugar as a sweetner. To use my new found knowledge from Kevin Thiele’s talk, I scavenged the pharmacy staff fridge and found a no-name can of cola. In 355 mL it contains 42 g of carbohydrate, which is worth 3 CARB Choices. A person needs at least 9 CARB Choices per day and that should be spread over 3 meals. Kevin said a female diabetic should aim for 3-4 CARB Choices per meal and a male diabetic should aim for 4-5 CARB Choices per meal. So if a female diabetic decided she wanted a can of cola, that would use up all her CARB Choices for one meal and she would need to choose things without carbohydrates in them like a salad and chicken breast for that meal. Now if that same female diabetic craves 5-6 cans of cola per day, that would put her at 16 CARB Choices and that puts her way over budget no matter what she eats. So if she replaces regular cola with artificially sweetened cola she will be much better off.
The four common artificial sweetners are: aspartame (Equal, Nutrasweet), saccharin (Sweet ‘N Low), acesulfame (Sunette), and sucralose (Splenda). They have been blamed for everything from cancer to seizures to Multiple Sclerosis to chronic fatigue. There is no good evidence that they cause any of these. We will talk about the top two saccharin and aspartame.
Saccharin has been around for more than a century. It is 300 times sweeter than sugar. This means if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.14 grams of saccharin to sweeten it. Since so little saccharin sweetens so much stuff it was used a lot in the two World Wars because sugar was scarce. In the 1970’s the Food and Drug Administration in the US started looking at saccharin safety. Initially it was found that huge doses of saccharin (way more per body weight than people would eat) caused bladder cancer in rats. Since then, the data has been reviewed and saccharin is now considered safe. The National Cancer Institute, the National Toxicology Program, the American Diabetes Association, American Dietetic Association, American Cancer Society, and American Medical Association all support the use of saccharin and say it is safe.
Aspartame has been available in Canada since 1981. It is about 200 times sweeter than sugar. So if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.21 grams of aspartame to sweeten it. As a side note, have you ever noticed that diet soft drinks foam or froth or bubble much more that regular sugared ones? That is because you need so much more sugar to sweeten it than aspartame, the sugared soft drinks are more viscous and thus foam less. Aspartame has been accused of causing everything from seizures to cancer to hair loss. None of these claims has ever been proven in a clinical trial. Many of the claims of damage I have heard about aspartame are because as aspartame is being broken down in the body, formaldehyde is produced. Formaldehyde is a poison, so aspartame must be a poison, right? Wrong. Many fruits and vegetables break down into small amounts of formaldehyde as well. This formaldehyde will break down into formic acid and then to water and carbon dioxide. Want further proof your body can handle small amounts of formaldehyde? That last hang over you had was due in part to formaldehyde. Ethyl alcohol changes in part into formaldehyde. Some of the pain of the hang over was due to too much formaldehyde in your body. But your body eventually metabolized it and the hang over went away. You get much more formaldehyde in your body from a hang over than from aspartame.
In general aspartame has been thoroughly tested by the Canadian and American authorities and found to be safe. There is one group that must avoid aspartame. This condition is called phenylketonuria or PKU, a disorder of amino acid metabolism. Accumulation of phenylalanine can lead to neurological, behavioral and dermatologic problems in this population. Since aspartame contains phenylalanine, patients with PKU should not use aspartame.
So I have already said I think artificial sweetners are a good option for diabetics. Should non-diabetics use them? In moderation, saccharine, aspartame, acesulfame potassium and sucralose appear to be safe. The FDA in the US and Health Canada have set acceptable daily limits of these sweetners and studies show that normal diets contain far less sweetners than these limits. So yes, in moderation, these sweetners are safe to use. Do I use them? Yes I do. One last word about moderation, though. Almost anything can be toxic if used too much. A condition called water toxicity can happen if you drink too much water. I bring this up because one of the clinic physicians was talking about a patient of theirs that drank 8-12 liters of diet soft drinks per day. This patient didn’t mention this diet related quirk to their physician for years. When the patient’s enormous diet soft drink consumption finally came out, the doctor could finally successfully cure the patient’s chronic diarrhea.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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