Dog Chews Off Sleeping Man’s Toes
Wednesday, July 23, 2003 News

“An Arizona man’s dog did not live up to being man’s best friend”, News Channel 5 reported. Dr. Poorsattar, Endocrinologist from Center for Diabetes does not quite agree with the comments on the news. She says, “when they say that a man’s best friend is his dog, it is absolutely true—especially when it comes to someone’s dead toes!”

While sleeping, Frank’s dog chewed off three of his gangrenous toes. Because he is diabetic, he did not feel a thing. His entire foot could have been gnawed off. Gangrene of the toes can cause toxemia and sepsis and even death. Doctors have to amputate the necrotic dead tissue as an emergency. Sometimes delay of only few hours can be deadly. The dog Baby D performed his best service by doing this clean out act. Sometimes Mother Nature helps by creating a defensive line of demarcation between living and nonliving tissue. It is not ugly, and it is not laughable, either. It is a very serious amputee, and most of the cases are preventable. Diabetes is responsible for 75% of non-traumatic amputations.

I had a patient who walked into my office and pulled out a piece of a bone from his pocket. “Hey Doc, this bone was sticking out of my foot ulcer and I was curious if it was a rock or foreign object, so I pulled it off.” It turned out to be actually one of his foot bone. Indeed he had no sensation of his feet and even when he walked he was unsure of his steps.
Nerve damage (Neuropathy) is one of the most distressing and common complications of diabetes and almost all diabetics suffer from this. Nerve damage can happen in various organs, skin or joints. This starts with pins and needles and then leads to loss of protective sensations resulting in gait problems , sores, ulcers and loss of legs. Nerve damage of body organs can be very deadly.

Signs of Diabetic Nerve Damage:

• Pain, burning, tingling or loss of feeling in the feet and hands
• Socks and Gloves syndrome.
• Sweating too much or too little
• Having trouble telling when your blood sugar is low
• Feeling light headed when you stand up
• Eye muscle paralysis with double vision
• Carpal tunnel and other nerve entrapments.
• Loosing the foot arch and the disorganization of foot bones
• Rock bottom feet—Charcot joint-Bones sticking out
• Red, hot swollen feet with no infection.
• Foot ulcers
• Diarrhea or constipation
• Lazy stomach, nausea, vomiting, gastro-paresis
• Failure in men to get erections
• Sexual dysfunctions for both sexes
• Bladder control problem
• Silent heart attacks
• Postural Hypotension
  
  
  
  Diabetic Neuropathy is caused by high blood sugars creating metabolic damage to nerve fibers. Also damage to small feeding capillaries of nerves further cause nerve fibre loss. Nutritional deficiency aggravates it too.

Treatment for Neuropathy. The best approach is to control diabetes to near normal, which may cause some healing and reversal of Neuropathy. Careful use of vitamins and supplements can facilitate healing. Some medications can block pain messages in nerve fibres. Protection of insensitive feet from injury, cuts, bruises and burns are important to avoid loss of extremity. Avoiding long hours on feet without proper foot support. Avoid alcohol and other medications that may aggravate Neuropathy. Pain medication is not the answer. At Center for Diabetes we have a new modality available to treat diabetic pain and neuropathy.

Anodyne Therapy System

Anodyne Therapy System is an exciting new technology has demonstrated excellent clinical results with Diabetic Peripheral Neuropathy including:

• Improved wound healing in chronic non-healing wounds
• Faster healing and prevention of pressure ulcers
• Potential to prevent amputations in diabetic patients
• Faster healing of all types of injuries and surgeries
• Better pain management
• Reduction in pain medications
• Restoration of protective sensation in diabetic peripheral neuropathy
• Improved gait and balance with potential to reduce falls due to DPN and arthritis pain
• The Anodyne system is approved by the FDA and has been proven effective in thousands of patients for reduction of pain and increasing local circulation. Anodyne is non-invasive, drug free and safe

People with cold and burning feet are welcome to try a free 10 minute session of Anodyne Therapy at Center for Diabetes by appointment. Call 805-653-5550.

Update in Diabetes Technology for Health Professionals in Ventura County held on
Thursday March 20, 2003

In pursuit of Improved methods of achieving blood sugar control
Science for Cure of Diabetes

20 million people in the United States have diabetes, costing $100 Billion a year. Only half of them are aware of it. Self-monitoring of blood glucose has become readily available to patients only in the last 20 years. Only 1/3 of people who know they are diabetic regularly check their blood sugar and use that information in self-adjustment of their own insulin and medications.

The self-monitoring devices have become very technologically advanced. You can have devices so small that you can carry them in your smallest pocket. It can test sugar, with smallest smudge of blood or body fluid, as fast as 4 seconds. Now we know tight control of blood sugar can make day and night differences in complications of diabetes like blindness, kidney failures, and heart failures. We can keep blood sugar in a narrow and near-normal range with the help of these new monitoring devices.

The discovery of insulin in 1920 changed the type-1 diabetes from a rapidly fatal condition to a chronic incurable illness. All efforts to achieve near-normal blood glucose values all day long made us face a three-fold higher risk of hypoglycemia, which is as dangerous as being on the road as a drunken driver. Not only that, it interfered with normal activities of life, requiring changes in lifestyle. Also we would have to carry the bulky paraphernalia of diabetics to give multiple injections, which was not always practical.

To overcome these hurdles, a lot of technological advances were made. We have lot of new tools on hand to utilize us in achieving and maintaining normal blood sugar. New kinds of insulin and their delivery techniques by Pens and Pumps and computerized pattern analysis have given us a whole new spectrum to mix and match our lifestyle. We no longer have to carry the stigma of needles any more.

Continuous Glucose Sensing devices, which measures blood sugar every 5 minutes, and Glucose Watches, which measure it every 15-20 minutes, gives us moment to moment insights to stay in that narrow range. The pattern of blood sugar even changes in sleep and the early part of the morning. Some people get low blood sugar comas when they are in sleep. To tackle that we have glucose delivery devices like insulin pumps, which can be programmed to deliver insulin at variable rates.

Of-course we are getting closer and closer to the Artificial Pancreas which can sense the blood glucose and deliver the required amount of insulin. We have ‘implanted insulin pumps’ into the abdominal space, which can deliver insulin close to the liver, and these pumps do not require being loaded with insulin very frequently. A new pancreatic peptide, Amylin and analogs are now available to counteract the fluctuations of sugar and replace the missing hormones of diabetics.

Insulin is now being precisely delivered to the body by prefilled disposable pens. Very soon we will have inexpensive disposable Insulin pumps. Insulin can be delivered by means other than injections, like in patches, sublingually, and by inhalations. We can inhale insulin according to size of our meals, and it is very effective, but a practical issue with this delivery is still being sorted out.

Finally we are approaching being insulin free and a cure for diabetes. Pancreatic transplants have become an accepted alternative therapy for subjects who are undergoing simultaneous kidney transplants. Since the first successful transplant in 1966, about 14,000 whole organ transplants have been reported to Pancreatic Transplant Registry.

In 1980 first successful Islet Cell Transplant was performed in a human. In June 2002, Islet cell transplant took a tremendous leap of success. Islet cell transplant is now simpler and less costly. It is much less invasive than whole pancreatic transplant and offers the hope that if performed earlier, it will result in excellent glucose control.

Immune Modulation, Vaccination, and Gene Therapy may find a cure for diabetes soon. The cure for diabetes by regenerating the insulin making Islet cells is in the near horizon. The INGAP (Islet Neogenesis Associated Protein) gene is identified to be responsible to regenerate the Islets that make insulin and other important hormones in the pancreas. This is an exciting approach to treating diabetes because it allows the body to heal itself.

There is no doubt the impact of Diabetes in US is profound.
Recent discoveries have evolved the intensive management of Diabetes, by decreasing the complications and increasing the quality of a longer life.
State of the Art care by Education

**This makes our Mission **

We are providing educational support to practices of all physicians in this region who also believe that education is the best public health policy for overcoming this disabling chronic condition of an epidemic magnitude. We do achieve the targets of care as outlined by American Diabetes Association and American Association of Clinical Endocrinologist and American Association of Diabetes Educators.

? Free Diabetes Screening
? Diabetes Education and Support Sessions
? Nutrition Counseling on Fridays
? Gestational Diabetes Program
? Ventura County Pump Support Group meets last Wednesday of each month
Joining in our mission today are :
• Abbott/ Medisense blood and ketone strips
• Anodyne Infrared waves for neuropathy and microcirculation
• Accu-Check Products and Soft-wares by Roche Diagnostics
• Animas, Pump and EZ Manager
• Ascensia Health Support Program-Bayer Care
• BD Consumer Health Care
• Cardio Dynamics
• Dana Pump
• Disetronic Pump
• Deltec-Cozmo Pump
• Lifescan
• Lilly – Disposable Pen
• NovoNordisk with a varieties of Insulin Delivery System
• Therasense – Free Style Meter and Tracker Manager
• Polymer-Technology for AIc and Cholesterol checks
• Roche Diagnostics with Meters and Educational System
• Sankyo/Cygnus – GlucoWatch Biographer
• VitaScan- Diabetics are perfect candidate for this study.

We are also sampling some of Ventura’s best dishes representing our cultural district from the following Restaurants:
• 71 Palm
• Austens
• Bariloche
• California Pizza Kitchen
• Capriccio & Coopers
• El Torito
• Good Thai & Peruvian
• Landmark 78
• Marine Sushi
• Mimi’s Cafe
• Palermo
• Pastabilities
• Payan
• Shamsis
• Yollies
• Zack’s Cafe

Diabetes Health Concern
December 12, 2002 Article

Mission Statement
Provide State of the Art Quality Care and Support to Diabetics
Focus for 2003 is State of the Heart in Diabetes
75% of all Diabetics Die of Heart Disease
Diabetes is a Metabolic-Cardio-Vascular Disease
Effective treatment consists of multiple targets of Care and Management to prevent Diabetes, Heart Disease and Associated Complications.

Facts and Figures

• 6% of American population has diabetes
• 20% of Americans have Dysmetabolic Syndrome
• This is an early setting of heart complication,
because of undiagnosed borderline diabetes which
includes cholesterol imbalance
• 30% increase in Diabetes in last few years
• 70% increase in diabetes above age 60
• Diabetes is a Growing Epidemic in US
• Type 2 Diabetes is increasing in youth and is
associated with changing food patterns and
increase in obesity
• In a study 70% of children in Ventura County are
found overweight
• Obesity will soon replace smoking as the leading
cause of preventable death in US

Diabetes is a Major Public Health Issue Facing America

• In Medicare age every third person has diabetes
• 64% of all diabetics are above age 60.
• Longevity has increased causing graying of America
and so is graying of Diabetes.
• In 2020 – 50 million Americans will be 65 and over
• 17 million diabetic’s healthcare cost was 137 Billion in 1995 and has substantially increased since.

Diabetes is a Major Cause of Disability and Death

Heart attacks related to diabetes kills more Americans than any other
disease. More women die of heart attack and diabetes than cancer
#1 Cause of Blindness
#1 Cause of Kidney Failure
#1 Cause of non traumatic Amputation of legs
#1 Cause of heart disease

Diabetes is a Vascular Disease

People are not dying in sugar coma any more, but of related heart and blood vessel condition.
Diabetes attacks blood vessels and arteries
It inflames the lining of arteries
It makes blood stickier
It increases bad cholesterol
Combination of above causes clogged arteries and
increases blood pressure which then accelerates the
damaging effects on blood vessels

The clogged arteries cut off oxygen and nourishment to vital organs and tissues, which then starve and die

Heart Attack
Have you heard of Painless Heart Attacks and Heart Failure? This happens to Diabetic.
Stroke
Diabetes clogs and ruptures the arteries of Brain
Eye
Diabetes weakens arteries of eye and causes bleeding Kidney
Diabetes makes kidney arteries leaky and
causes protein spillage and failure
Neuropathy
Diabetes causes pain and numbness in hands and feet
Skin breaks down easy
Tissues do not heal-Bacteria start to feed on skin

Gangrene-Amputation
Tissue death in a living body is called Gangrene
Dying tissue makes Toxins affecting other living
tissue, protection of which requires immediate
amputation cut it off fast and clean
If you loose one leg with diabetes, the second limb
is at risk within 2 years

There is no doubt the impact of Diabetes in US is profound. Recent discoveries regarding heart in diabetes have evolved, resulting in increased emphasis on State of the Art early diagnosis and intensive management of Diabetes, by decreasing the damaging effects of Diabetic-Vascular disease and increasing the quality of a longer life.
**This makes our Mission **
• Free Diabetes Screening every Monday
• Diabetes Education and Support Sessions
on Wednesdays
• Nutrition Counseling on Fridays
• Ventura County Pump Support Group meets last Wednesday of each month at
Community Memorial Hospital

Improved methods
of achieving blood sugar control by

Utilizing Diabetes Technology
By Gulnar Poorsattar, M.D., F.A.C.E., C.D.E.

20 million people in the United States have diabetes, costing $100 Billion a year. Only half of them are aware of it. Self-monitoring of blood glucose has become readily available to patients only in the last 20 years. Only 1/3 of people who know they are diabetic regularly check their blood sugar and use that information in self-adjustment of their own insulin and medications.

The self-monitoring devices have become very technologically advanced. You can have devices so small that you can carry them in your smallest pocket. It can test sugar, with smallest smudge of blood or body fluid, as fast as 4 seconds. Now we know tight control of blood sugar can make day and night differences in complications of diabetes like blindness, kidney failures, and heart failures. We can keep blood sugar in a narrow and near-normal range with the help of these new monitoring devices.
The discovery of insulin in 1920 changed the type-1 diabetes from a rapidly fatal condition to a chronic incurable illness. All efforts to achieve near-normal blood glucose values all day long made us face a three-fold higher risk of hypoglycemia, which is as dangerous as being on the road as a drunken driver. Not only that, it interfered with normal activities of life, requiring changes in lifestyle. Also we would have to carry the bulky paraphernalia of diabetics to give multiple injections, which was not always practical.

To overcome these hurdles, a lot of technological advances were made. We have lot of new tools on hand to utilize us in achieving and maintaining normal blood sugar. New kinds of insulin and their delivery techniques by Pens and Pumps and computerized pattern analysis have given us a whole new spectrum to mix and match our lifestyle. We no longer have to carry the stigma of needles any more.
Continuous Glucose Sensing devices, which measures blood sugar every 5 minutes, and Glucose Watches, which measure it every 15-20 minutes, gives us moment to moment insights to stay in that narrow range. The pattern of blood sugar even changes in sleep and the early part of the morning. Some people get low blood sugar comas when they are in sleep. To tackle that we have glucose delivery devices like insulin pumps, which can be programmed to deliver insulin at variable rates.
Of-course we are getting closer and closer to the Artificial Pancreas which can sense the blood glucose and deliver the required amount of insulin. We have ‘implanted insulin pumps’ into the abdominal space, which can deliver insulin close to the liver, and these pumps do not require being loaded with insulin very frequently. A new pancreatic peptide, Amylin and analogs are now available to counteract the fluctuations of sugar and replace the missing hormones of diabetics.

Insulin is now being precisely delivered to the body by prefilled disposable pens. Very soon we will have inexpensive disposable Insulin pumps. Insulin can be delivered by means other than injections, like in patches, sublingually, and by inhalations. We can inhale insulin according to size of our meals, and it is very effective, but a practical issue with this delivery is still being sorted out.

Finally we are approaching being insulin free and a cure for diabetes. Pancreatic transplants have become an accepted alternative therapy for subjects who are undergoing simultaneous kidney transplants. Since the first successful transplant in 1966, about 14,000 whole organ transplants have been reported to Pancreatic Transplant Registry.

In 1980 first successful Islet Cell Transplant was performed in a human. In June 2002, Islet cell transplant took a tremendous leap of success. Islet cell transplant is now simpler and less costly. It is much less invasive than whole pancreatic transplant and offers the hope that if performed earlier, it will result in excellent glucose control.
Immune Modulation, Vaccination, and Gene Therapy may find a cure for diabetes soon. The cure for diabetes by regenerating the insulin making Islet cells is in the near horizon. The INGAP (Islet Neogenesis Associated Protein) gene is identified to be responsible to regenerate the Islets that make insulin and other important hormones in the pancreas. This is an exciting approach to treating diabetes because it allows the body to heal itself.
There is no doubt the impact of Diabetes in the US is profound. Recent discoveries have evolved into intensive management of Diabetes by decreasing the complications and increasing the quality of a longer life.

State of the Art care by Education
**This makes our Mission **
We are providing educational support to practices of all physicians in this region who also believe that education is the best public health policy for overcoming this disabling chronic condition of epidemic magnitude. We do achieve the targets of care as outlined by American Diabetes Association and American Association of Endocrinologist.

_ Free Diabetes Screening
_ Diabetes Education and Support Sessions
_ Nutrition Counseling on Fridays
_ Ventura County Pump Support Group meets
last Wednesday of each month

Press Release - June 26, 2003

DIABETES HOTLINE FOR NEWLY DIAGNOSED DIABETICS IN VENTURA COUNTY

CDC estimates 1 in 3 people born in 2000 are likely to become Diabetic
Currently 1 in 3 over the age of 60 are Diabetic.

Ventura County Insulin Pump Group met at Community Memorial Hospital auditorium and issued this press release. June 25, 2003

The Ventura County Insulin Pump Group has passed this resolution to adopt “Mentoring Program” for counseling and support of the newly diagnosed diabetics in Ventura County. Physicians today fully recognize the need for support and education, but time constraints and managed cares do not necessarily permit so.

Diabetes is a high maintenance disease. It is a public health issue. It cost us $130 billion heath dollars a year. It is also very demoralizing condition that hinders in quality of care. Well-trained diabetics can share the burden and act as a peers role model and motivate others in self-care.

Accepting the diagnosis of diabetes is a long process. Its cycle is typical of any grief reaction. To gain the confidence in self-care it is necessary to have a steady friend who can empathize with the process. You have to have someone to be accountable to with the demands of self-care, apart from parents, spouse or doctors.

There is a rooster of on-call volunteers available by calling the Hotline for newly diagnosed Diabetics at 805-653-5550.

January 19, 2003, Article
Center for Diabetes

By Dr. Gulnar Poorsattar

Obesity, Diabetes, Lipid, and Heart

Many Public Health Officials and Organizations have tried to warn the public about the dangers of obesity. One of the strongest warning came from the US Surgeon General who stated that a failure to address overweight and obesity "could wipe out some of the gains we have made in the areas such as heart disease, several forms of cancer, and other chronic health problems."

Death due to heart disease has decreased by 9% but incidence of diabetes has gone up by 33%. Obesity among children has doubled. We are all well aware of relatively higher mortality rate, poorer quality of life, and substantial healthcare cost due to obesity.

We need to treat Obesity aggressively. There are several barriers to the treatment of Obesity. Those barriers are no different than what were faced by smoking cessation, cholesterol and diabetes management programs.

The pessimism about treatment outcomes, lack of long-term efficacy and high financial burden of Obesity care, has kept health professionals less aggressive in intervention.
First line intervention for obesity is nutritional counseling, exercise, and therapeutic life style changes. The results are only 10% reduction, but this is shown to be effective enough to improve diabetes control, blood pressure and cholesterol profile.

We need a public health approach to prevent Obesity and Diabetes. The public health approach targets behavioral, sociocultural, and environmental factors that contribute to obesity.
Genes may have individual susceptibility to weight gain, but the obesity epidemic is not due to genetic factors, since the increase in the rate of obesity is too abrupt. Current obesity epidemic is caused largely by an environment, that promotes excessive food intake and discourages physical activity.

Easy availability and marketing of foods, increase in the use of computers and television viewing, reduction of physical education in schools and physical activities at work. Food industry spends $26 billion on advertising annually. Los Angeles district schools sell $4.5 million worth of sodas annually. The National Soft Drink Association claims that obesity is about the couch and not the can.

Last year more than half Americans attempted weight loss and spent more than $33 billion on products and services. Nonetheless Obesity has continued and doubled since 1980.

We need neighborhoods more walk-able, safer and more integrated network of footpaths and bike lanes, increasing the range of healthy foods in schools and work cafeterias. We need an aggressive and steady approach in schools, homes, work place and at doctor’s offices. The need to prevent Obesity has become urgent.

Metabolic Syndrome: A Truly Deadly Quartet. Also known as Syndrome X. Insulin Resistance. Obesity, Hypertension, Cholesterol, and Glucose intolerance (borderline-diabetes) markedly increase the heart attack and death. They co-exist in 15-30% of Americans.
The best treatment is prevention in early stage. We recognize and treat all elements of this metabolic syndrome by aggressive and supportive techniques.
You have Metabolic Syndrome if:
Waist 35 inches in women and 40 inches in men
Triglyceride level more than 150
HDL in women <50 and in men < 40
Blood Pressure > 130/85
Fasting glucose > 110