Category Archives: Diabetes

Asking the Important Questions: Why Do Old Folks Tend to Have Ugly Toenails?

The NYT’s Well Blog has some potential answers: fungus infections, poor circulation, diabetes, accumulated trauma.

I question the assertion that inadequate drying after bathing is an issue.

I like the advice not to wear the same shoes every day.

Steve Parker, M.D.


The Endocrine Society is Worried About Environmental Chemicals: You Should Be, Too

See text for mention of pancreatic alpha and beta cells

See text for mention of pancreatic alpha and beta cells

A panel of university-based scientists convened by The Endocrine Society recently reviewed the available literature on health effects of endocrine-disrupting chemicals (aka EDCs). The executive summary is available free online. Some excerpts:

The full Scientific Statement represents a comprehensive review of the literature on seven topics for which there is strong mechanistic, experimental, animal, and epidemiological evidence for endocrine disruption, namely: obesity and diabetes, female reproduction, male reproduction, hormone-sensitive cancers in females, prostate cancer, thyroid, and neurodevelopment and neuroendocrine systems. EDCs such as bisphenol A, phthalates, pesticides, persistent organic pollutants such as polychlorinated biphenyls, polybrominated diethyl ethers, and dioxins were emphasized because these chemicals had the greatest depth and breadth of available information.

*  *  *

Both cellular and animal models demonstrate a role for EDCs in the etiology of obesity and T2D [type 2 diabetes]. For obesity, animal studies show that EDC-induced weight gain depends on the timing of exposure and the age of the animals. Exposures during the perinatal period [the weeks before and after birth] trigger obesity later in life. New results covering a whole range of EDC doses have underscored the importance of nonmonotonic dose-response relationships; some doses induced weight increase, whereas others did not. Furthermore, EDCs elicit obesity by acting directly on white adipose tissue, al- though brain, liver, and even the endocrine pancreas may be direct targets as well.

Regarding T2D, animal studies indicate that some EDCs directly target 􏰁beta and alpha cells in the pancreas, adipocytes, and liver cells and provoke insulin resistance together with hyperinsulinemia. These changes can also be associated with altered levels of adiponectin and leptin— often in the absence of weight gain. This diabetogenic action is also a risk factor for cardiovascular diseases, and hyperinsulinemia can drive diet-induced obesity. Epide- miological studies in humans also point to an association between EDC exposures and obesity and/or T2D; however, because many epidemiological studies are cross-sectional, with diet as an important confounding factor in humans, it is not yet possible to infer causality.


Bix at Fanatic Cook blog says foods of animal origin are the major source of harmful persistent organic pollutants, some of which act as ECDs.

Keep your eyes and ears open for new research reports on this critically important topic.

Steve Parker, M.D.

Sugar-Sweetened Beverages May Cause 9% of Type 2 Diabetes Cases in U.S.

…according to a meta-analysis published in the British Medical Journal.

At this point, it’s more accurate to say the two are associated than to say the drinks cause diabetes.

Yet Another Potential Cause of Type 2 Diabetes: Fructose

Lumps of Diabetes

Cubes of Diabetes?

A Pharm.D (Dr of Pharmacology) and a pair of MD’s surveyed much of the available scientific literature—both animal and human studies—and concluded that fructose is a major culprit in the rise of type 2 diabetes and prediabetes. Fructose does its damage by increasing insulin resistance. ScienceDaily has the details.

Be aware that their conclusion is certainly not universally accepted. I just read “Pathogenesis of type 2 diabetes mellitus” at and saw no mention of fructose. Under dietary factors, they mainly talked about obesity and how that increases insulin resistance, leading to elevated blood sugars, while the reverse happens with weight loss. I haven’t looked at all the research so I have no definite opinion yet on the fructose-diabetes theory; I’m skeptical.

Fructose is a type of simple sugar. Common dietary sources of fructose are fruits, table sugar (aka sucrose, a 50:50 combination of glucose and fructose molecules), and high-fructose corn syrup (which is usually 42 or 55% fructose).

Damaging effects, if any, of fructose in these fruits may be mitigated by the fiber

Damaging effects, if any, of fructose in these fruits may be mitigated by the fiber

A few quotes from ScienceDaily:

“At current levels, added-sugar consumption, and added-fructose consumption in particular, are fueling a worsening epidemic of type 2 diabetes,” said lead author James J. DiNicolantonio, PharmD, a cardiovascular research scientist at Saint Luke’s Mid America Heart Institute, Kansas City, MO. “Approximately 40% of U.S. adults already have some degree of insulin resistance with projections that nearly the same percentage will eventually develop frank diabetes.”

*   *   *

While fructose is found naturally in some whole foods like fruits and vegetables, consuming these foods poses no problem for human health. Indeed, consuming fruits and vegetables is likely protective against diabetes and broader cardiometabolic dysfunction, explained DiNicolantonio and colleagues. The authors propose that dietary guidelines should be modified to encourage individuals to replace processed foods, laden with added sugars and fructose, with whole foods like fruits and vegetables. “Most existing guidelines fall short of this mark at the potential cost of worsening rates of diabetes and related cardiovascular and other consequences,” they wrote.

If you’re eating a typical Western or American diet, you’ll reduce your fructose consumption by moving to the Mediterranean diet, the Advanced Mediterranean Diet, Low-Carb Mediterranean Diet, or the Paleobetic Diet.


Steve Parker, M.D.

Elevated Fasting Blood Sugars May Increase Your Risk for Pancreatic Cancer


Insulin from the pancreas’ beta cells is a major regulator of blood sugar levels

A recent meta-analysis found that elevated fasting blood glucose levels, even below the diabetic range, are associated with higher risk of developing pancreatic cancer. This is important because you can take action today to lower your fasting blood sugar level, which may lower your risk of pancreatic cancer over the long-term. The researchers conclude that…

Every 0.56 mmol/L [10 mg/dl] increase in fasting blood glucose is associated with a 14% increase in the rate of pancreatic cancer.

In the developed world, your risk of getting an invasive cancer is roughly one in four. Pancreatic cancer is the most lethal. Surgery is the way to cure it, but at the time of diagnosis only two in 10 patients are candidates for surgery because the cancer has already spread. Pancreatic cancer is the fourth leading cause of cancer death in the USA and the fifth in the UK. Nevertheless, pancreas cancer is not terribly common; the US has 50,000 new cases annually. As a hospitalist, I run across one or two new cases of pancreas cancer every year.

We’ve known for years that type 2 diabetes is linked to pancreatic cancer, with diabetics having twice the risk of nondiabetics.

What if you have elevated fasting blood sugars? There’s no proof that reducing them to the normal range will reduce your risk of pancreatic cancer. But if it were me, that’s what I’d shoot for, by losing excess fat weight, exercising, and eating a Low-Carb Mediterranean Diet book detail page at

Other that type 2 diabetes and prediabetes, some other risk factors for pancreas cancer are:

  • heredity
  • smoking
  • sedentary lifestyle
  • body mass index over 30 (obesity in other words)

You can alter most of those risk factors. Why not get started today?

Steve Parker, M.D.

PS: If you’re not sure if your fasting blood sugar’s elevated, click here.

Do Artificial Sweeteners Cause Overweight and Type 2 Diabetes?

We don’t know with certainty yet. But a recent study suggests that non-caloric artificial sweeteners do indeed cause overweight and type 2 diabetes in at least some folks. The study at hand is very small, so I wouldn’t bet the farm on it. I’m not even changing any of my recommendations at this point.

exercise for weight loss and management, dumbbells

“Too many diet sodas” doesn’t explain this whole picture


The proposed mechanism for adverse metallic effects is that the sweeteners alter the mix of germs that live in our intestines. That alteration in turn causes  the overweight and obesity. See MedPageToday for the complicated details. The first part of the article is about mice; humans are at the end.

Some quotes:

“Our results from short- and long-term human non-caloric sweetener consumer cohorts suggest that human individuals feature a personalized response to non-caloric sweeteners, possibly stemming from differences in their microbiota composition and function,” the researchers wrote.

The researchers further suggested that these individualized nutritional responses may be driven by personalized functional differences in the micro biome [intestinal germs or bacteria].


Diabetes researcher Robert Rizza, MD, of the Mayo Clinic in Rochester, Minn., who was not involved with the research, called the findings “fascinating.”

He noted that earlier research suggests people who eat large amounts of artificial sweeteners have higher incidences of obesity and diabetes. The new research, he said, suggests there may be a causal link.

“This was a very thorough and carefully done study, and I think the message to people who use artificial sweeteners is they need to use them in moderation,” he said. “Drinking 17 diet sodas a day is probably a bad idea, but one or two may be OK.”

I won’t argue with that last sentence!

Finally, be aware the several clinical studies show no linkage between human consumption of non-caloric artificial sweeteners and overweight, obesity, and T2 diabetes.

Steve Parker, M.D.

Four In Ten U.S. Adults Will Develop Diabetes

Like type 1 diabetics, many type 2's need insulin shots

Like type 1 diabetics, many type 2’s need insulin shots

Researchers affiliated with the U.S. Centers for Disease Control estimate that 40% of American adults will develop diabetes, mostly type 2. The CDC’s prior estimate was the one of every three Americans born in 2000 would develop diabetes. Some snippets from the article abstract:

On the basis of 2000—11 data, lifetime risk of diagnosed diabetes from age 20 years was 40·2% for men and 39·6% for women, representing increases of 20 percentage points and 13 percentage points, respectively, since 1985—89.

The number of life-years lost to diabetes when diagnosed at age 40 years decreased from 7·7 years in 1990—99 to 5·8 years in 2000—11 in men, and from 8·7 years to 6·8 years in women over the same period.

Years spent with diabetes increased by 156% in men and 70% in women.

The good news is that you can decrease your odds of type 2 diabetes via diet and exercise. I can’t prove it, but I bet the Advanced Mediterranean Diet prevents some cases of diabetes. The single most important issue in preventing type 2 diabetes is avoiding obesity.

Steve Parker, M.D.