Tag Archives: glycemic control

What’s Inside My Ebook, Metabolism.com?


My ebook Metabolism.com is now available; I think you will find it a great resource for many of the common problems members have asked me about over the past 15 years. Buy it now and use it for years to come. Don’t forget to check out the Weight Loss and Weight Gain Programs included for free!

Chapter 1: What Is Metabolism? 9

Turning Food into Energy 10
The Importance of Hormones 11
Role of Metabolism in Weight Loss or Gain 14
Is My Metabolism Healthy? 16

Chapter 2: What Makes Your Metabolism Fast or Slow? 17

The Role of the Thyroid 22

Chapter 3: How to Increase or Decrease Metabolism 25

Problems with Losing Weight 25
Problems with Gaining Weight 34
A Pleasurable Exercise Routine is a Must 39

Chapter 4: Fact vs. Fiction—Smoking and Weight Loss 41

Chapter 5: Thyroid Treatment 47

How Are T3 and T4 Regulated? 48
Types of Thyroid Diseases 49
Hyper- and Hypothyroidism 49
Thyroid Nodules 51
Is Your Thyroid Nodule Hot? 53
Thyroid Treatments 54
Using Thyroid Function Tests To Diagnose Disease 56
Hyperthyroidism Treatments 57
Hypothyroidism Treatments 58
T3 Plus T4 Combination Therapy 59
How to Talk to Your Endocrinologist 66
The Recent Shortage of Armour Thyroid 67

Chapter 6: Diabetes Treatment 73

The Bad News—Major Stumbles in the Treatment of Diabetes 74
The Call for Tight Glycemic Control 74
2010 Diabetes Treatment Guidelines Lack Credibility 76
Setbacks in Diabetes Drug Development 81
The Failure of Inhaled Insulin 86
Dangerous Commercial Weight Loss Programs 87
Perhaps the Biggest Stumble of Th em All 89
The Good News—What Really Works 90
Diet and Exercise 90
Weight Loss Surgery 94
Incretins 95

Chapter 7: Hormone Treatments 99

Hormone Replacement Therapy—Estrogen 101
Heart Health 101
Breast Cancer 103
Benefits of Estrogen: Brain Function and Blood Pressure 104
Testosterone Replacement for Men 106
Testosterone Replacement Options 107
Benefits of Testosterone Replacement 108
Potential Risks 109
Human Growth Hormone in Adults 111
Diagnosing Growth Hormone Deficiency 113
Benefits of Growth Hormone Supplementation 113
Adrenal Fatigue: Fact or Fiction? 115

Conclusion 117

The Birth Of Metabolism.com 119
My Path Into Endocrinology 121
Recent Contributors On Metabolism.com 125

Appendix 1: Personal Nutrition Profile 127
Appendix 2: Ultimate Weight Gain Program 145
Appendix 3: Food Journal 165

Relevant Studies

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Part 2. Another Troubled Year for Endocrinologists


For several years the leaders of the endocrine community have been advocating “tight” control of blood sugars in diabetics particularly for hospitalized patients. For hospitalized diabetics, tight control means keeping the blood sugar in the normal “non-diabetic” range 24 hours, seven days a week. For diabetics not in hospital the goal is a glycohemoglobin A1c level of less than 6%, which is considered the dividing line between diabetic and normal blood sugars.

For hospitalized diabetic patients with an enormous range of illnesses, stresses, diets and requirements for diagnostic procedures, instituting tight control requires a special nurse for each patient and creates a logistical nightmare for the hospital. The call for tight glucose control in hospitalized patients was founded on a few small studies with questionable study design. The movement among the academic community for tight control had gone so far that a special credentialing committee and curriculum was being organized to create a super-subspecialty of endocrinologists who would manage this new brand of in-hospital diabetes care. This would give physicians with this new credential a virtual monopoly on in-hospital diabetes care. The focus on creating this monopoly seemed to me a more powerful incentive than to address the need to create a valid new super-subspecialty.

The science behind the call for this degree of blood sugar control for diabetics, particularly of hospitalized patients, was flimsy at best. It defied the common knowledge that it takes over 10 years to see physical evidence of high blood sugars on body organs. In addition, clinicians with years of experience treating diabetes in hospitalized patients had seen first that non-ideal blood sugars rarely had any clinical impact on their patients out-comes. In an editorial last year, I had called upon the endocrine community to give up their quest to formalize diabetes care around unrealistic demands for tight glycemic control http://www.metabolism.com/2008/05/25/a-year-of-stumbles-for-diabetes-care-in-the-us-part-ii/

Fortunately, recent major studies have proven that not only does this rigorous degree of tight control not benefit hospitalized and non-hospitalized diabetics but the mortality (death) and complication rates were even higher for tight control patients. Most notably the NIH recently called for the end of the ACCORD study which examined the response to “tight” glycemic control of out-patient diabetics with high risk of heart disease and stroke. The ACCORD study was ended early when it became clear that “tight” glycemic control resulted in a worse outcome for diabetics than conventional glucose control. As far as studies of diabetics in the intensive care unit, back as far as 2003 a UK study revealed worse outcomes with tight control. Hopefully putting an end to the quest for this seemingly ill conceived goal are the results of the NICE-SUGAR study just published in the New England Journal of Medicine showing increased death rates for diabetics receiving tight glycemic control in the intensive care unit.

[This information is not intended as medical advice. For recommendations for treatment always seek the advice of your own physician. Please refer to the disclaimer at metabolism.com for policies governing the use of all posts on this site.]

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