By Annette R. Karnash, R.N., M.N.

Type 2 diabetes could possibly lower fasting glucose levels the following morning by as much as 6% by taking 2 Tbsp of vinegar at bedtime.

By Annette R. Karnash, R.N., M.N.

Recent studies have identified several positive results from taking Byetta.  Byetta is known to help in weight loss by not only reducing the appetite, thus allowing the patient to feel sated and by decreasing the amount of time it takes for food to pass from the stomach, thereby resulting in a sensation of fullness for a longer period of time.  It also works on the pancreas to produce more insulin and on the liver to decrease glucose production.  In addition, Byetta reduces blood sugars and A1C levels to 7% or less and has significantly reduced the amount of insulin needed.

In an Italian study, Byetta was either able to regenerate or produce healthy beta cells after one year of treatment when it was discovered that type 2 patients had an increase in C-Peptide secretion, a byproduct of the body’s insulin output.

There have been reports of type 2 patients taking Byetta developing acute pancreatitis, especially after the does was doubled.  However, this was reversed and symptoms did subside when the does was decreased or discontinued.

Byetta has been used in conjunction with other diabetes medications since its introduction into the market in 2005, but Amylin and Lilly Pharmaceuticals will petition the FDA in the near future to offer it as a monotherapy for type 2 diabetes.  A long acting release (LAR) version of Byetta, injected only once a week as compared to the present twice a day version will also be considered and would be a significant improvement in the treatment of type 2 diabetes.  This may provide and additional option in the use of Byetta before starter insulin earlier in the continuum of care is considered in the treatment of diabetes.

By Annette R. Karnash, R.N., M.N.

Of all the essential minerals necessary to maintain life, magnesium is perhaps the most important for preventing and reversing signs of neural and neuromuscular over-excitement. Magnesium is a key element in stabilizing the nerve cell. Without it, the nerve would be in a constant state of excitement.

Magnesium is usually a part of a salt such as magnesium hydroxide, or “Milk of magnesia”, magnesium sulfate or “Epsom Salts”, both of which are used to treat G.I. disorders. Magnesium carbonate is a key ingredient in arthritis strength “Bufferin”.

Magnesium gets its name from the Greek city of Magnesia, where huge amounts of magnesium carbonate, used as a laxative during the Italian Renaissance were located. Magnesium is the central element in the chlorophyll molecule. Magnesium has a role in regulating the distribution of electrolytes and nutrients. It is used to treat heart attacks and Congestive Heart Failure and magnesium deficiency is associated with these conditions and with diabetes. Emphasis is placed on obtaining adequate calcium and Vitamin D to prevent or treat osteoporosis, yet not often are we instructed to increase magnesium. Magnesium and calcium compete for the same absorption sites in the G.I. tracts, so that high concentrations of one or the other results in poor absorption of the lesser. If calcium intake is increased magnesium should also be increased. Since calcium is an activator as in muscle contraction and nerve excitability, magnesium is a depressor, as in muscle and nerve relaxation. They counterbalance one another.

Magnesium may be an under diagnosed and under appreciated electrolyte irregularity, especially for patients with cardiovascular disease and diabetes. Some of the drugs used to treat hypertension, thiazide diuretics, may add to the problem associated with magnesium deficiency. Magnesium deficiency may be due to urinary magnesium loss secondary to chronic glycosuria. Replenishment and maintenance of both intracellular and extracellular magnesium levels need consideration. Magnesium is second to potassium as the most abundant intracellular cation in the body. It is part of chemical reaction that involves the formation and utilization of adenosine triphosphate (ATP) which the body uses for energy storage and transfer. As a co-factor of many enzymes its roles has been implicated in glucose utilization. Magnesium is a factor in over 30 enzymatic reactions, such as Na, K. ATPase pump activity, which is important in keeping intracellular and extracellular ionic concentrations balanced. Magnesium deficiency impairs this pump, resulting in potassium depletion and sodium accumulation.

The recommended daily allowance (RDA) of magnesium is 5mg/kg body weight and the average American diet provides only about 150 mg of the 400mg recommendation. Foods highest in magnesium, such as nuts, dried fruits, green vegetables, fish and whole grains, do not make up a major portion of the American diet. Appropriate meal plans for diabetic patients may also restrict a number of foods in this group due to the sugar, cholesterol and high caloric content. Factors such as pregnancy, aging and stress can increase magnesium requirements through impaired absorption, decreased renal function and increased cellular magnesium elimination. Several renal, endocrine and gastro-intestinal conditions may cause hypomagnesemia. Because magnesium chloride is highly soluble, it will reach the small intestine, the site of maximal absorption, as free magnesium ions, a form necessary for uptake. Other magnesium salts are relatively insoluble and provide less free magnesium for absorption and chloride appears to improve magnesium absorption. Health care professionals should be alert for patients who may be at risk for magnesium deficiency, especially patients with co-existing diabetes and cardio-vascular disease. They may benefit from magnesium supplementation.

A valuable laboratory test for evaluating blood sugar levels measure Glycosolated Hemoglobin also known as A1C. Proteins that have glucose molecules attached to them (glycosolated peptides) are elevated seven fold in diabetics. Normally 5-7% of hemoglobin is combined with glucose. Mild elevation in blood sugar results in an A1C concentration of 8-10%, while severe elevation results in concentrations of up to 20%.

Since the average life span of an RBC (red blood cell) is 120 days, the A1C assay represents time averaged value of hemoglobin over the preceding 2-4 months. It is extremely valuable in providing a simple, useful method for assessing treatment effectiveness and patient compliance. A1C determination along with a fasting blood sugar can be used in some cases to diagnose diabetes but it is not the sole criteria for diagnoses. Approximately one third of those with diabetes diagnosed with glycosolated hemoglobin have a normal A1C. An 1C coupled with fasting blood sugar and a 2 hour post prandial level provide a more accurate diagnosis. The A1C assay is helpful in determining the relative glucose load on the system and to monitor therapy.

The C-Peptide test can tell physicians the amount of insulin the pancreas is making.  However, this test is not for everyone.  It is used primarily for diabetes research, but there are times when it is useful, particularly in treating non-insulin dependent diabetes.  When insulin is released from the pancreas, most is soaked up by the liver where blood tests are unable to detect it.  C-Peptide goes through the liver and when the body produces a molecule of insulin, it also makes one of C-Peptide.  By measuring C-Peptide, the test gauges the amount of insulin made.  This test can detect the levels of insulin being made by type 2 diabetics.  With normal to high levels, oral agents are usually successful.  Low levels normally require insulin injections.