Cardiovascular Profiler

The ubiquitous brachial cuff method, the blood pressure cuff put on the arm while sitting on the exam table, was developed in 1890 and gained widespread clinical acceptance for blood pressure recording after confirmation of its prognostic value in 1917. Mayo Clin Proc. 2006;81(8):1057-1068

Since that time, brachial cuff sphygmomanometry has migrated from the physician’s office to 24-hour monitoring and home use, with electronic methods replacing the Korotkov sound technique for determining systolic and diastolic pressure.

Detailed instrumental studies, required by regulatory bodies, reveal inaccuracies of all cuff methods for recording true intra-arterial pressure. A major source of inaccuracy in assessing left ventricular load of the heart is the amplification of the pressure wave in its transit from the central aorta to upper limb arteries, as extensively studied by Earl H. Wood at the Mayo Clinic in Rochester, Minn, in the 1950s.

This limitation can be overcome by combining newer methods using radial artery waveform analysis in conjunction with conventional cuff sphygmomanometry to noninvasively measure the central aortic pressure waveforms.
Recent studies using radial tonometry (touching the tissue for vibration or wave form) have proved that this is more effective than conventional manometry (squeezing arm to get a pressure) in predicting cardiovascular events and gauging response to therapy.

Measurement of central as well as peripheral arterial pressure and physiology is becoming increasingly used as an office practice and a laboratory procedure. The Cardiovascular Profiler used in my office can measure small vessel disease which can have specific therapy (l-arginine) given to reverse most of invisible part of the complications of diabetes.

More devices in this class are coming on the market that can also measure aortic pressure, arterial elasticity in age related distribution. Mathematical analysis of the wave form itself will be able to follow the progress of treatment of autonomic neuropathy to be measured. Specific measurement will allow development of new treatments to reverse this complication.

It’s your time.

Inhaled Insulin

We will be using inhaled insulin in the office before long. Several of our patients did volunteer in the early studies and contributed greatly to the new product. Initially it was quite a hassle but more recently it is quite well accepted by the patients who have used inhaled insulin.

Compared to insulin injections inhaled insulin has a similar rate of onset time to peak action, but a longer duration of action. After inhalation of insulin, only 10 percent is absorbed so this inefficiency no doubt contributes to the higher cost of this system.

In both type 1 and Type II diabetes, when combined with appropriate basal insulin, equivalent glycemia was obtained.

Long-term effects of the lung are yet unknown. Contraindications to the use of this system are smokers, asthma and chronic obstructive pulmonary disease. It is used before meals and can be used with a basal insulin. It is not as easy to use as the usual inhalers you may know and the patient must use glucose testing as before.

In type 1 diabetes, it may be difficult to calibrate inhaled doses because the minimum amount is equivalent to three subcutaneous units. Problems with hypoglycemia are unchanged.

Seizure of Byetta at Airports

We have had patients have their Byetta seized today when passing through the inspection areas when entering Europe. Remember to have it have some pharmaceutical packaging that you can display.

That did not work for one person so the next thing to try is to offer to give yourself an injection while you give your speech on what it does for you. Then offer to give them an injection. On second thought, don’t do that.

If all is lost, although Byetta is not available in Europe its major action is to create efficiency of your insulin whether you are a type 2 or 1. You will probably lose some of the efficiency so you will need more of your usual medication.

Remember that the omission of the Byetta is not life threatening it is only a short term inconvenience.

Levemir for 1 & 2

Levemir seems to have advantages that have made it my favorite basal insulin.
* It has the least amount of growth factor
* Least amount of weight gain in type 2
* Low rate of hypoglycemia
* It comes in a flexpen, easy and accurate

It seems to have less variable insulin absorption which makes the action more predictable. Some patients have considered it twice a day, like some have done with Lantis, but this is an individual variation. New England Journal of Medicine 2005, 352; 174-83

Analogue Insulins

The correction to the last E-News is enclosed. The fast acting insulin referred to is Apidra, not the basal insulin Levemir. Sorry about that. Thanks to you all who quickly picked up the error.

All patients with diabetes 1 require insulin therapy and the majority (90%-95%) of patients with diabetes 2 will require insulin therapy within 6-10 years of diagnosis. Recently the development of analogues has been a tremendous advance in the field of insulin therapy.

Recently we have had the introduction of new insulins that closely mimic the basal and bolus insulin normal patterns. Almost like the normal pancreas would do. This allows greater flexibility for personal life without forfeiting control.

Lantus and Levemir are the two basal insulins and the fast acting insulins until recently have been Humalog and Novolog. These have been much improved insulin preparations.

Now we have Apidra, the fastest acting over all and therefore better than the rest.

We will go over all these preparations in the next few days to give you an idea of what is best for you.

Analogue Insulins

All patients with diabetes 1 require insulin therapy and the majority (90%-95%) of patients with diabetes 2 will require insulin therapy within 6-10 years of diagnosis. Recently the development of analogues has been a tremendous advance in the field of insulin therapy.

Recently we have had the introduction of new insulins that closely mimic the basal and bolus insulin normal patterns. Almost like the normal pancreas would do. This allows greater flexibility for personal life without forfeiting control.

Lantus and Levemir are the two basal insulins and the fast acting insulins until recently have been Humalog and Novolog. These have been much improved insulin preparations. Now we have Levemir, the fastest acting over all and therefore better than the rest.

We will go over all these preparations in the next few days to give you an idea of what is best for you.

Bluetooth Glucose Monitor

There are new products that might be helpful to those who need to know what family members at doing at a distance. This has been something that was developed for those with type 1 but it appears that family members with type 2 are using it as well.

David Mendosa has long been a writer that has a passion for things that will improve the life of people with diabetes. He has diabetes 2 and follows new technology with a special dual interest.