Posts made in August, 2012

Generic Actos is now Available

Posted by on Aug 30, 2012 in News | 0 comments

This past month the US FDA approved the first generic version of Actos (pioglitazone) for lowering blood sugars in type 2 diabetics, available in 15, 30, and 45 mg tablets.

Actos is classified as an insulin sensitizer. The drug has been shown to increase uptake of glucose into the body tissues. Some studies show that the drug may also preserve pancreatic function. The other benefit of actos is that it doesn’t cause hypoglycemia episodes. It works best when combined with changes in diet and exercise.

Generic actos will offer an affordable treatment for patients with type 2 diabetes, which can be a life long illness. While this is great news, diabetics should know that there’s evidence linking pioglitazone to bladder cancer.

In addition, the drug may worsen CHF (congestive heart failure) because of fluid retention. It may be used in combination with metformin, sulfonylurea or insulin. Other adverse effects of actos include weight gain and fluid retention.

For diabetics who have no heart disease, generic actos is an excellent treatment. For those with heart disease, it’s important to speak to your physician before jumping on the actos bandwagon. And while generic actos is cheap, it’s still not a better or cheaper drug than metformin.

Contributed by Dr. Steven Bhimji, M.D.

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Overcoming White Coat Syndrome / White Coat Hypertension

Posted by on Aug 28, 2012 in News | 0 comments

You may have heard of the term white coat syndrome in the doctor’s office – the condition where patients have elevated blood pressure (greater or equal to 140/90 mmHg) in the clinic setting and blood pressure readings less than 140/90 mmHg out of the office. It’s called white coat hypertension because the anxiety and nervousness are thought to come from seeing healthcare professionals with white coats. It happens to a lot of people who have high blood pressure. The doctor will ask whether you are taking your medicines every day. If you’re taking them regularly, the doctor will ask you to record your blood pressure at home both during the day and night time. It’s important to monitor your blood pressure at home daily for at least 2-3 weeks.

Another way to uncover white coat syndrome is to have the doctor provide a small portable monitor to wear for about 24 hours. The device measures blood pressure every 15 to 20 minutes during the day and every 30 to 60 minutes during sleep. Using the data it then calculates your average day time blood pressure and average night time blood pressure.

Both methods will help doctors determine whether you’re truly hypertensive or if your high blood pressure in the office is due to white coat syndrome. For hypertensive patients, it’s helpful to see if your current treatments are working.

If your blood pressure is less than 120/80 mmHg, it’s considered normal. If your blood pressure falls between 120/80 mmHg and 139/89 mmHg, you have pre-hypertension. If your blood pressure is 140/90 mmHg or greater, you have hypertension or high blood pressure. For a 24 hour monitoring device, normal average blood pressure should be less than 130/80 mmHg. Your day time blood pressure has to be less than 135/85 mmHg to be normal. Night time blood pressure has to be less than 120/70 mmHg to be normal.

If you have white coat syndrome or hypertension, you should make a few changes in your lifestyle. These include:

  • Cut down salt (sodium) in your meals
  • Maintain a healthy body weight
  • Keep yourself physically active
  • Quit smoking if you smoke
  • Avoid alcoholic drinks
  • Get a home blood pressure monitor
  • Reduce stress at home and work by learning relaxation techniques and meditation
  • Avoid smoking, caffeinated drinks, and exercise before going to your doctor’s appointment

Patients with white coat syndrome are at risk for developing high blood pressure in the future. Studies showed that people with white coat syndrome have slightly higher risk for heart diseases and stroke compared to people with normal blood pressure.

Contributed by Patricia Hsiao M.D.
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Do Type 2 Diabetics Benefit from Bariatric Surgery?

Posted by on Aug 27, 2012 in News | 1 comment

Bariatric surgery is being heavily advocated for obese people. When it’s done well, the results are satisfactory. Now there are some experts who suggest that bariatric surgery can help obese diabetics lose weight fast, which helps over come the insulin resistance and reduces the risk of heart disease.

A recent study from Italy reveals that obese diabetics who under went bariatric surgery fared much better than those who were treated with medical therapy.
At 2 years none of the medically treated diabetic patients had remissions, but nearly 75% of diabetics who underwent gastric bypass achieved remissions. Other benefits included significantly higher improvement in blood lipids levels compared with medical therapy. Moreover, the blood pressure was also reduced in the surgically treated patients.

Should All Obese Diabetics be Lining up for Bariatric Surgery?

Definitely not. Bariatric surgery is performed by many surgeons, and the quality of results can vary greatly. For unknown reasons the surgery doesn’t work for everyone and the benefits aren’t always sustained. The majority of people regain their weight within 2 years.

Finally, the surgery is prohibitively expensive and the complications are life threatening. For those interested in surgery, the most important thing is to find a reputable surgeon. In the meantime, changes in lifestyle, exercise and a decrease intake of calories cannot be emphasized enough. It’s not only safe, but costs almost nothing.

Contributed by Dr. Steven Bhimji, M.D.
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Lipid Lowering Dietary Supplements

Posted by on Aug 22, 2012 in News | 1 comment

If you have high cholesterol, you might want to pay close attention to what you eat. Diet plays a major role in treating chronic conditions such as diabetes, high cholesterol, and high blood pressure. There are many commercial products and herbal supplements that claim to lower blood cholesterol, but not all are effective. Make sure you talk to your doctor before you start taking any herbal supplements, as some may interact with the medications you’re already taking.

Fish Oil or Omega-3-Fatty Acid

Research studies have shown that fish oil or omega-3-fatty acid, fibers, and some nuts have effects on cholesterol. Fish oil has been studied for many potential health benefits and some populations who eat a lot of fish products have lower rates of heart disease. You may hear that fish oil is good for many medical conditions, but not all of them have been proven by scientific studies. However, we know for fact that fish oil and omega-3-fatty acids have affect on high cholesterol and high blood pressure. Many studies have been done, on laboratory animals and some on humans for high cholesterol, that came to the conclusion that fish oil reduces triglyceride (a type of cholesterol) level by a large amount in patients with high triglycerides. It may also raise HDL (good cholesterol) level by a small amount. It’s recommended to consume at least one or two servings of oily fish a week. Fish with lots of omega-3 include tuna, salmon, mackerel, mullet, anchovy, trout, sardines, halibut and herring. You can also get omega-3-fatty acids from flaxseed oil, canola oil and soybean oil. If you don’t like to eat fish, you can take a fish oil supplement (1 gram daily). Talk to your doctor if you’re concerned about your daily dose of fish oil supplement along with your other medicines. Fish oil supplements may contain small amounts of vitamin E and you shouldn’t take more than the recommended dosage.


We know that fibers are good for your intestines and can help prevent colon cancer. Studies showed that soluble fibers in psyllium, wheat, celery, oatmeal and oat bran can reduce LDL cholesterol (bad cholesterol) level. You can also get fibers from eating fruits. Therefore, it’s recommended to have 5-10 grams of fibers a day.


Studies have shown that walnut has effect on lowering total cholesterol and LDL cholesterol (bad cholesterol). Similar effects are found from almonds and pistachios as well. You should try to consume a handful of nuts a few times a week. Make sure to get the ones which are unsalted or not sugar-coated. Some studies indicated that people who consume nuts more than two times a week may benefit from lowering the risks of heart disease.

Others with Small Effect on Cholesterol Level

There’s been a few studies done on green tea in regards to cholesterol level and researchers found that drinking unsweetened green tea can reduce LDL cholesterol by a small amount. In addition, soy products are rich in unsaturated fats and fibers compared to protein from meats. Studies showed that soy protein improves cholesterol level and blood pressure.

Contributed by Patricia Hsiao M.D.
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Does Diabetes Have an Affect on Sex Drive in Women?

Posted by on Aug 20, 2012 in News | 0 comments

While it’s well known that diabetes affects sexual function in men, very little is known about how diabetes affects sexual function in women. For the most part it’s always been assumed that diabetic women don’t suffer from decreased libido (unlike men).

Now a study from the University of California reveals that sexual activity in diabetic women is also profoundly affected. Not only do middle aged women with diabetes have low levels of sexual desire, they also have less satisfaction and decreased frequency of sexual activity. In addition, women who are treated with insulin tend to have more difficulty with lubrication than those diabetics who don’t use insulin.

The study also observed that end organ complications of diabetes was also associated with decreased sexual function. Women with diabetes and heart disease, kidney failure, and/or peripheral neuropathy, had lower sexual desire and decreased sexual satisfaction.

This study emphasizes that doctors should include a sexual history in diabetic women and counsel them on how to prevent end organ damage.

As far as treatments are concerned that can increase libido, there isn’t much for women. Viagra is used by men and anecdotal reports indicate that some diabetic women also find it useful. Some women have found low dose testosterone useful to boost the sex drive. Best advice for diabetic women – speak to your medical doctor before trying out any medications to boost your sex life.

Contributed by Dr. Steven Bhimji, M.D.
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