Archive for Diabetes

Extreme Lipids II

Posted in Diabetes, Heart Disease with tags , , , , , on September 23, 2008 by Dr. CJ

There aren’t many lipid panels that stun me, which is probably a bad sign – that we are becoming more tolerant of slothen behavior and excessive hyperlipidemia, knowing that there are medications to rescue one from years of lousy self-care.

This gentleman had a most impressive lipid panel, perhaps forcing you to ask how he is even alive.

Total Cholesterol    1248  (normal < 200)

LDL                         n/a  (normal < 130)

– invalid when Triglycerides > 300

HDL                        n/a  (normal >39)

– invalid when Triglycerides > 1200

Triglycerides          8062  (normal <150)

This very nice 40-something gentleman presented to me in clinic in DKA (Diabetes KetoAcidosis) – his first doctor visit in 10+ years.  He was continually thirsty (polydipsia), continually urinating large amounts (polyuria), and had lost 40 pounds over the past 3 months . . . unintentionally.

He knew that he had Diabetes Mellitus, for he had witnessed the disease in nearly all of his family members and recognized these classic symptoms.  Unfortunately, he waited to the point that he developed DKA. 

DKA is a complicated process – briefly, the body is so overwhelmed with high glucose in the bloodstream that it is no longer able to utilize glucose in the tissues (muscle, brain, etc.) and the pancreas is exhausted from pumping out so much insulin that it stops doing so.  The result is that the body cannot utilize glucose as a fuel source and must resort to breaking down fat (hence the weight loss) to provide fuel for the tissues.  This process creates a toxic acidic environment in the bloodstream, potentially deadly.

I admitted him to the hospital, and we achieved control over his diabetes.  It appears that he does, in fact, have Type 2 Diabetes Mellitus (DM) – formerly known as Adult-Onset Diabetes Mellitus.  DKA is far more common in Type 1 DM, but occasionally does occur in Type 2 DM.

But, about those lipids . . . there a couple notable findings:

  • the person who drew his blood immediately noticed how fatty the blood appeared
  • he had Xanthomas (cholesterol deposits) on his elbows
  • the in-house glucose machine misread his glucose as normal (the true serum test drawn at the same time was markedly elevated)
  • he had no problems with his pancreas – he dodged a bullet.  When the triglycerides are above 500, one is at risk for pancreatitis.  At 8000, it’s a miracle he didn’t kill off his pancreas (or maybe he did, and that’s why he’s not making insulin – regardless he didn’t have any lab evidence of pancreatitis)

  The quickest and easiest treatment for such severe hyperlipidemia and hypertriglyceridemia in a person with diabetes is correction of the diabetes.  I’m anxiously looking forward to rechecking those numbers, now that he is on a treatment regimen.  I’ll post an update.


Inhaled insulin was doomed from the start

Posted in Diabetes, Rants and Raves with tags , , on March 8, 2008 by Dr. CJ

This recent news blip about a new inhaled insulin failing caught my attention, months after the big flop of Exubera, Pfizer’s inhaled insulin product. It was meant as an alternative delivery method of insulin for individuals with diabetes mellitus who were resistant to the use of injections. Interesting idea, in theory, but in practice is a mess.

I had the delightful opportunity (read sarcasm) to discuss this product with some Pfizer pharmaceutical reps who of course were pushing it as the latest, greatest insulin product. Not to pat myself on the back, but I told them it wouldn’t catch on like they were hoping . . . for a few reasons.

  • The apparatus was apparently difficult to use. It was a clumsy-looking handheld canister, into which packets of inhalable insulin were dispersed, and then the contents of that chamber were inhaled. Dosing was very limited due to the sizes of the insulin packets, which would then require multiple inhalations to receive one “dose”. How’s that any easier?!?
  • My biggest grudge with it was that insulin is not meant to be dispensed into the lungs and thus posed grave danger. Insulin is a tumor growth factor [note: “tumor” not necessarily being a malignant process]. An example of this function in action is the deposit of tissue beneath the skin where frequent injections are performed. Why would anyone put that product in their lungs, with potential for decreased lung function and inappropriate tissue growth? * Part of my duty to my patients is to protect them from these marketing blunders. Last thing I want is a surge in lung cancer cases.

I hope my intellectual assaults on the Exubera reps played a little role in hurrying Exubera off the market. There are a few other new drugs I’ve recently heard about that should also provide me good fodder to toy with the pharmaceutical reps.

* “Growth for the sake of growth is the ideology of the cancer cell.” – Edward Abbey