Increased Heart Rate And Cardiovascular Risk In Hypertension And Diabetes

Increased heart rate and cardiovascular risk in hypertension and diabetes

High resting heart rate increases the risk of cardiovascular morbidity and mortality in the general population, as well as in those with hypertension, and in those with type 2 diabetes. Drugs that increase the heart rate may adversely affect cardiovascular health
Population studies have shown that there is a relationship between high resting heart rate and increased risk of cardiovascular events and mortality. This has also been obvious in most studies in patients with hypertension - findings summarized in a report from a Consensus Meeting of the European Society of Hypertension in 2005.1 This report was updated in 2016 in a statement from the Second Consensus Conference, which concluded that heart rate measurement should be included in the routine assessment of the hypertensive patient.2 A similar view was reported from a group reviewing publications from the Asia Pacific region.3
An analysis of prospective studies in patients with hypertension found that night-time heart rate measured by ambulatory recordings was a better predictor of mortality than elevated heart rate in the clinic.4 The analysis included 7602 hypertensive patients with ambulatory blood pressure (BP) and heart rate recordings from 6 prospective studies in Italy, Japan and Australia. They defined tachycardia as an office heart rate >85 beats/minute or a night-time heart rate >76 beats/minute (these represented the upper quintiles). Patients with elevated heart rate in the clinic but normal night-time heart rate were considered to have white-coat tachycardia whereas those with normal clinic heart rate but Continue reading

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Apple Cider Vinegar and Diabetes

OK, y’all. I wrote about this several years ago, but now I’m serious. If you want to control any type of diabetes better, consume vinegar before meals and at bedtime. Start today! It lowers post-meal and fasting glucose levels.
In a study from Arizona State University, subjects took a drink of 20 grams of apple cider vinegar, 40 grams of water, and 1 teaspoon of saccharin with each meal. (I think stevia might be better than saccharin.) Those with insulin resistance who drank the vinegar had 34% lower postprandial (after-meal) glucose compared to controls.
These postprandial benefits had been found before. It was thought that vinegar might slow the absorption of carbohydrate into the blood, or slow the breakdown of starches into sugars. This effect would mimic the effect of drugs like acarbose (brand name Precose).
But the 2004 study cited above reported that vinegar reduced postprandial glucose more in subjects who were highly insulin resistant. The authors say this result shows that vinegar increases insulin sensitivity, perhaps acting similarly to metformin.
Now studies have found that vinegar at bedtime reduces fasting blood glucose in the morning, indicating that vinegar might promote insulin production, like nateglinide (Starlix).
Pretty amazing that a simple chemical like vinegar (acetic acid) could have the benefits of three different classes of diabetes drugs, and all for a few cents a dose! It’s likely good for both Type 2 and Type 1, especially for lowering postprandial glucose. And postprandial glucose levels account for 30% to 70% of A1C values. Vinegar ha Continue reading

Insulin Prices Skyrocketing

America’s getting plenty angry about the rising cost of insulin—and no wonder. Between 2002 and 2013, the average price for this life-saving, injectable drug used by nearly 10 million Americans with diabetes has tripled, according to the American Diabetes Association (ADA). “No one who relies on insulin should have to wonder if they’ll be able to afford it,” the ADA asserts in an online petition for its Stand Up for Affordable Insulin campaign.1
The ADA’s action doesn’t stand alone. In November, Vermont senator and former contender for the Democratic presidential nomination Bernie Sanders fired off a letter calling on the U.S. Justice Department and the Federal Trade Commission asking for an investigation of pharmaceutical makers Eli Lilly, Novo Nordisk and Sanofi for possibly colluding on insulin price increases.2
“Not only have these pharmaceutical companies raised insulin prices significantly—sometimes by double digits overnight—in many instances the prices have apparently increased in tandem,” noted the letter, co-signed by Rep. Elijah Cummings (D-MD). “We have…heard from our constituents that the life-saving insulin they need is increasingly unaffordable,” And in early January 2017, the New York law firm Bernstein Litowitz Berger & Grossmann sued Novo Nordisk on behalf of the Lehigh County (PA) Employees' Retirement System alleging the company “reported materially false and misleading earnings and forecasts” that were “inflated” by price fixing.
That’s not all. In a rapidly-changing insulin market, the recent introduction in the U. Continue reading

Why the Rising Cost of Insulin?

Recently, during diabetes management counseling sessions, I taught several patients with type 1 or 2 diabetes about the cost of insulin. They were having trouble affording their daily insulin injections even with health insurance. According to a Bloomberg news report “5 of the 27 branded drugs were diabetes drugs, which climbed at least 20% in cost in the past year.” A study in JAMA (Journal of The American Medical Association) states, “insulin prices have tripled from 2002-2013.”
The ADA (American Diabetes Association) announced “a resolution and petition that calls for transparency in the insulin supply chain to ensure insulin is affordable for those who need it.” There is currently an online petition sponsored by the ADA “to solve this crisis and protect millions of Americans who need insulin to stay alive.” Insulin is a necessity, not an option, for those who suffer with diabetes type 1 and many with diabetes type 2. The petition is available at www.stopdiabetes.com/insulin for people interested in signing on. Let’s examine some of the issues surrounding and relating to insulin through the times:
History of Insulin:
1921 – Frederick Banting and Charles Best did an experiment using a dog’s pancreas and discovered insulin.
1923 – Nearly a century ago, “a trio of scientists in Canada” sold the patent rights to the University of Toronto for $3.oo.
1923 – Near the end of 1923, Eli Lilly was brought on to mass produce insulin in America. This lead to the commercialization of insulin. Insulin was made from beef and pork and many people developed a Continue reading

New ADA 2017 Standards of Medical Care in Diabetes

Psychological health, access to care, expanded and personalized treatment options and the tracking of hypoglycemia emphasized.
The ADA Standards of Medical Care in Diabetes are established and revised annually by a Professional Practice Committee. The committee is a multi-disciplinary team of 12 leading experts in the field of diabetes care, and includes physicians, diabetes educators, registered dietitians and others who have experience in areas that include adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning and pregnancy care. Members of the committee must disclose potential conflicts of interest with industry and/or other relevant organizations.
Psychological health, access to care, expanded and personalized treatment options, and the tracking of hypoglycemia in people with diabetes are key areas emphasized in the American Diabetes Association’s (Association) new 2017 Standards of Medical Care in Diabetes (Standards). Produced annually by the Association, the guidelines focus on screening, diagnosis and treatment to provide better health outcomes for children, adults and older people with type 1, type 2 or gestational diabetes, and to improve the prevention and delay of type 2 diabetes. The Standards were published as a supplement to the January 2017 issue of Diabetes Care.
The Standards also include the findings of a new report on diabetes staging, titled “Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis” (Differentiation), which is being published at the same time in Di Continue reading