If you regularly read my postings, you probably realize that I tend to write about a specific topic on a weekly basis. However, this week, my posting will be something of a "mishmash" of three topics—all diabetes-related, however.
I just got back from the American Association of Diabetes Educators (AADE) 35th Annual Meeting, held in Washington, D.C. this past week. Someone told me that about 3,500 educators (nurses, dietitians, physicians, and more) attended. When you get that many people together, you’re bound to learn something, and I did. I wanted to share some pearls of wisdom, tidbits of interest, and interesting facts that I picked up over the last few days.
If things seem a little jumbled, well, it’s because they are. Since you can’t attend more than one session at a time, I picked and chose those sessions that were of most interest and relevance to me. So, here goes:
Welchol, or colesevelam, is not a new medication. It’s primarily been used as a cholesterol-lowering agent, binding to bile acids in the intestine. Welchol can be used along with a statin. What’s new about Welchol is that it’s also been found to lower HbA1c levels by at least 0.5%. That may not sound like a lot, but a 1% drop in HbA1c lowers your risk of diabetes complications by 37% and your risk of a heart attack by 14%. Welchol lowers LDL (bad) cholesterol by about 15% to 17%, as well.
If used as a diabetes drug, Welchol can be prescribed along with metformin, a sulfonylurea, or with insulin. It’s not meant to be taken by itself. Also, it’s not intended to treat Type 1 diabetes. As with any medication, it comes with a few side effects: It can raise triglyceride (blood fat) levels, so caution should be used if your triglyceride levels are higher than 500 mg/dl. Welchol can also decrease the absorption of fat-soluble vitamins (A, D, E, K), and it shouldn’t be used in people with gastroparesis, other gastrointestinal disorders, or a history of bowel obstruction. Finally, you need to take six tablets every day, so if you’re not a pill-taker, this drug may not be for you.
This session was given by one of my Joslin colleagues, Katie Weinger, Ed.D., R.N., who does a lot of behavioral health research. Some of the takeaway messages that I got from this session were that as the duration of Type 2 diabetes increases, one is more prone to hypoglycemia (low blood glucose); that there’s no evidence that hypoglycemia causes a substantial decline in cognition; and that in people with hypoglycemia unawareness (the inability to feel classic symptoms of hypoglycemia), symptoms of hypoglycemia can be restored.
Also, she mentioned that, in the Diabetes Control and Complications Trial (DCCT), a landmark Type 1 diabetes study, 55% of hypoglycemic episodes occurred during sleep. My conclusion is that this means one should occasionally set an alarm at 2 or 3 AM to do a blood glucose check or think about wearing a continuous glucose sensor, especially if your lows tend to occur overnight.
Hypoglycemia and driving don’t mix, so it’s crucial to check your blood glucose before you get in the car, and if you think you’re on the way down, to eat a snack to be on the safe side. By the way, men are more likely than women to drive when they’re low.
A last tidbit of interest: Pediatric endocrinologists are more likely to talk to their patients—meaning adolescents—about the dangers of driving when low than adult endocrinologists.
This excellent talk was given by a pharmacist, who relayed that people with diabetes are almost twice as likely to use supplements as people without diabetes, and that 20% to 30% of people with diabetes take some kind of supplement. She provided a lot of helpful information; two supplements that she discussed that I wasn’t aware of were chia (yes, as in Chia Pets!) and salacia.
Chia, also called Salvia hispanica, became popular after being mentioned on Oprah (of course!). These are little seeds that are very high in fiber and can lower insulin levels, post-meal blood glucose levels, and blood pressure.
Salacia works to inhibit an enzyme in the gastrointestinal tract to help lower post-meal glucose levels (much like the drug acarbose [Precose], although actually more potent). So, expect to hear and read more about these two supplements in the near future.
All in all, this conference was another success, and in the future I’ll share more “clinical pearls” that I picked up over the last four days.