Fish of the Week – Basa fish

February 19, 2013 at 10:05 AM | Posted in fish | 2 Comments
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The basa fish, Pangasius bocourti, is a type of catfish in the family Pangasiidae. Basa are native to the Mekong River Delta in Vietnam

Basa fish Vinh Long market, Việt Nam

Basa fish Vinh Long market, Việt Nam

and Chao Phraya basin in Thailand. These fish are important food fish with an international market. They are often labeled in North America and Australia as “basa fish” or “bocourti”. In the UK, the species is known mainly as “river cobbler”, with “basa” also being used on occasion. In Europe, these fish are commonly marketed as “pangasius” or “panga”. Other related shark catfish may occasionally be falsely labeled as basa fish, including Pangasianodon hypophthalmus (iridescent shark) and Pangasius pangasius (yellowtail catfish).

The body of a basa fish is stout and heavy. The rounded head is broader than it is long, with the blunt snout having a white band on its muzzle. This species grows to a length of 120 centimetres (47 in) SL.

Basa fish feed on plants. They spawn at the onset of flood season and the young are first seen in June, averaging about 5 cm by mid-June.

Tests by Asda and Tesco in the UK have found no trace of contaminants. Test from AQIS found trace levels of malachite green, but no other contaminants.

In 2002, the United States accused Vietnam of dumping catfish, namely Pangasius bocourti and Pangasius hypophthalmus, on the American market, charging the Vietnamese importers, who are subsidized by Vietnam’s government, of unfair competition. With pressures from the U.S. catfish industry, the United States Congress passed a law in 2003 preventing the imported fish from being labelled as catfish, as well as imposing additional tariffs on the imported fish. Under the U.S. Food and Drug Administration ruling, only species from the family Ictaluridae can be sold as true catfish. As a result, the Vietnamese exporters of this fish now label their products sold in the U.S. as basa fish or bocourti.

At the height of the “catfish war”, U.S. catfish farmers and others were describing the imported catfish as an inferior product. However, Mississippi State University researchers found imported basa were preferred in a taste test 3-to-1.

Basa has become fairly common in the UK under the name “Vietnamese river cobbler” or just “river cobbler”. It is mainly being sold through the large supermarkets in both fresh and frozen forms. It is marketed as a cheaper alternative to traditionally popular white fish, such as cod or haddock. Young’s Bluecrest use it in some of their frozen fish products, choosing to use the name basa instead of cobbler.

UK Trading Standards officers have stated cobbler is being fraudulently sold as cod by some fish and chip retailers to capitalise on the large difference in the wholesale price between the two, i.e., cobbler costs less than half the price of cod. This practice was highlighted by the successful prosecution of two retailers (using DNA evidence) one in July 2009, and another in April 2010.

One of America’s Favorites – Chocolate

October 1, 2012 at 9:59 AM | Posted in cooking | Leave a comment
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Chocolate is a raw or processed food produced from the seed of the tropical Theobroma cacaotree. Cacao has been cultivated for at


least three millennia in Mexico, Central and South America. Its earliest documented use is around 1100 BC. The majority of the Mesoamerican people made chocolate beverages, including the Aztecs, who made it into a beverage known as xocolātl [ʃo’kolaːt͡ɬ], a Nahuatl word meaning “bitter water”. The seeds of the cacao tree have an intense bitter taste, and must be fermented to develop the flavor.

After fermentation, the beans are dried, then cleaned, and then roasted, and the shell is removed to produce cacao nibs. The nibs are then ground to cocoa mass, pure chocolate in rough form. Because this cocoa mass usually is liquefied then molded with or without other ingredients, it is called chocolate liquor. The liquor also may be processed into two components: cocoa solids and cocoa butter. Unsweetened baking chocolate (bitter chocolate) contains primarily cocoa solids and cocoa butter in varying proportions. Much of the chocolate consumed today is in the form of sweet chocolate, combining cocoa solids, cocoa butter or other fat, and sugar. Milk chocolate is sweet chocolate that additionally contains milk powder or condensed milk. White chocolate contains cocoa butter, sugar, and milk but no cocoa solids.

Cocoa solids contain alkaloids such as theobromine and phenethylamine, which have physiological effects on the body. It has been linked to serotonin levels in the brain. Some research found that chocolate, eaten in moderation, can lower blood pressure. The presence of theobromine renders chocolate toxic to some animals, especially dogs and cats.

Chocolate has become one of the most popular food types and flavors in the world. Gifts of chocolate molded into different shapes have become traditional on certain holidays: chocolate bunnies and eggs are popular on Easter, chocolate coins on Hanukkah, Santa Claus and other holiday symbols on Christmas, and chocolate hearts or chocolate in heart-shaped boxes on Valentine’s Day. Chocolate is also used in cold and hot beverages, to produce chocolate milk and hot chocolate.

Cocoa mass was used originally in Mesoamerica both as a beverage and as an ingredient in foods. Chocolate played a special role in both Maya and Aztec royal and religious events. Priests presented cacao seeds as offerings to the deities and served chocolate drinks during sacred ceremonies. All of the areas that were conquered by the Aztecs that grew cacao beans were ordered to pay them as a tax, or as the Aztecs called it, a “tribute”.

The Europeans sweetened and fattened it by adding refined sugar and milk, two ingredients unknown to the Mexicans. By contrast, the Europeans never infused it into their general diet, but have compartmentalized its use to sweets and desserts. In the 19th century, Briton John Cadbury developed an emulsification process to make solid chocolate, creating the modern chocolate bar. Although cocoa is originally from the Americas, today Western Africa produces almost two-thirds of the world’s cocoa, with Côte d’Ivoire growing almost half of it.

The word “chocolate” entered the English language from Spanish. How the word came into Spanish is less certain, and there are multiple competing explanations. Perhaps the most cited explanation is that “chocolate” comes from Nahuatl, the language of the Aztecs, from the word chocolātl, which many sources derived from xocolātl [ʃokolaːtɬ], from xococ ‘sour’ or ‘bitter’, and ātl ‘water’ or ‘drink’. However, as William Bright noted the word “chocolatl” does not occur in central Mexican colonial sources, making this an unlikely derivation. Santamaria gives a derivation from the Yucatec Maya word “chokol” meaning hot, and the Nahuatl “atl” meaning water. Sophie and Michael D. Coe agree with this etymology.

Pointing to various sources dating from the time period of the Spanish conquest, they identify cacahuatl (“cacao water”) as the original Nahuatl word for the cold beverage consumed by the Aztecs. Noting that using a word with caca in it to describe a thick, brown beverage would not have gone over well with most speakers of Spanish due to the fact that caca means faeces in Spanish, the Coes suggest that the Spanish colonisers combined the Nahuatl atl with the Yucatec Maya chocol, for unlike the Aztec, the Maya tended to drink chocolate heated. The Spanish preferred the warm Mayan preparation of the beverage to the cold Aztec one, and so the colonisers substituted chocol in place of the culturally unacceptable caca.

More recently, Dakin and Wichmann derive it from another Nahuatl term, “chicolatl” from eastern Nahuatl, meaning “beaten drink”. They derive this term from the word for the frothing stick, “chicoli”. However, the Coes write that xicalli referred to the gourd out of which the beverage was consumed and that the use of a frothing stick (known as a molinollo) was a product of creolisation between the Spanish and Aztec; the original frothing method used by the indigenous people was simply pouring the drink from a height into another vessel.

Several types of chocolate can be distinguished. Pure, unsweetened chocolate contains primarily cocoa solids and cocoa butter in

varying proportions. Much of the chocolate consumed today is in the form of sweet chocolate, combining chocolate with sugar. Milk chocolate is sweet chocolate that additionally contains milk powder or condensed milk. In the U.K. and Ireland milk chocolate must contain a minimum of 20% total dry cocoa solids; in the rest of the European Union the minimum is 25%. “White chocolate” contains cocoa butter, sugar, and milk, but no cocoa solids. Chocolate contains alkaloids such as theobromine and phenethylamine, which have some physiological effects in humans, but the presence of theobromine renders it toxic to some animals, such as dogs and cats. It has been linked to serotonin levels in the brain. Dark chocolate has been promoted for unproven health benefits, as it seems to possess substantial amount of antioxidants that reduce the formation of free radicals.

White chocolate is formed from a mixture of sugar, cocoa butter and milk solids. Although its texture is similar to milk and dark chocolate, it does not contain any cocoa solids. Because of this, many countries do not consider white chocolate as chocolate at all. Although first introduced by Hebert Candies in 1955, Mars, Incorporated was the first to produce white chocolate within the United States. Because it does not contain any cocoa solids, white chocolate does not contain any theobromine, meaning it can be consumed by animals. It is usually not used for cooking.

Dark chocolate is produced by adding fat and sugar to the cacao mixture. The U.S. Food and Drug Administration calls this “sweet chocolate”, and requires a 15% concentration of chocolate liquor. European rules specify a minimum of 35% cocoa solids. Dark chocolate, with its high cocoa content, is a rich source of epicatechin and gallic acid, which are thought to possess cardioprotective properties. Dark chocolate has also been said to reduce the possibility of a heart attack when consumed regularly in small amounts. Semisweet chocolate is a dark chocolate with a low sugar content. Bittersweet chocolate is chocolate liquor to which some sugar (typically a third), more cocoa butter, vanilla and sometimes lecithin have been added. It has less sugar and more liquor than semisweet chocolate, but the two are interchangeable in baking.

Unsweetened chocolate is pure chocolate liquor, also known as bitter or baking chocolate. It is unadulterated chocolate: the pure, ground, roasted chocolate beans impart a strong, deep chocolate flavor.

Raw chocolate, often referred to as raw cacao, is always dark and a minimum of 75% cacao. Because the act of processing results in the loss of certain vitamins and minerals (such as magnesium), some consider raw cacao to be a more nutritious form of chocolate.

Some people who purchase chocolate off the store shelf can be disappointed when they see whitish spots on the dark chocolate part. This is called chocolate bloom and is not an indication of chocolate gone bad. Instead, this is just an indication that sugar and/or fat has separated due to poor storage.

Roughly two-thirds of the entire world’s cocoa is produced in West Africa, with 43% sourced from Côte d’Ivoire, where child labor is a common practice to obtain the product. According to the World Cocoa Foundation, some 50 million people around the world depend on cocoa as a source of livelihood. In the UK, most chocolatiers purchase their chocolate from them, to melt, mold and package to their own design.

Chocolate is any product made primarily of cocoa solids and cocoa butter.

Production costs can be decreased by reducing cocoa solid content or by substituting cocoa butter with another fat. Cocoa growers object to allowing the resulting food to be called “chocolate”, due to the risk of lower demand for their crops. The sequencing in 2010 of genome of the cacao tree may allow yields to be improved.

Chocolate is made from cocoa beans, the dried and partially fermented seeds of the cacao tree (Theobroma cacao), a small (4–8 m (or 15–26 ft) tall) evergreen tree native to the deep tropical region of the Americas. Recent genetic studies suggest that the most common

Chocolate is created from the cocoa bean. A cacao tree with fruit pods in various stages of ripening

genotype of the plant originated in the Amazon basin and was gradually transported by humans throughout South and Central America. Early forms of another genotype have also been found in what is now Venezuela. The scientific name, Theobroma, means “food of the deities”. The fruit, called a cacao pod, is ovoid, 15–30 cm (or 6–12 in) long and 8–10 cm (3–4 in) wide, ripening yellow to orange, and weighs about 500 g (1 lb) when ripe.

Cacao trees are small, understory trees that need rich, well-drained soils. They naturally grow within 20 degrees of either side of the equator because they need about 2000 millimeters of rainfall a year, and temperatures in the range of 21 to 32 °C. Cacao trees cannot tolerate a temperature lower than 15 °C (59 °F).

The three main varieties of cacao beans used in chocolate are criollo, forastero, and trinitario.

Representing only five percent of all cocoa beans grown, criollo is the rarest and most expensive cocoa on the market, and is native to Central America, the Caribbean islands and the northern tier of South American states. There is some dispute about the genetic purity of cocoas sold today as criollo, as most populations have been exposed to the genetic influence of other varieties. Criollos are particularly difficult to grow, as they are vulnerable to a variety of environmental threats and produce low yields of cocoa per tree. The flavor of criollo is described as delicate yet complex, low in classic chocolate flavor, but rich in “secondary” notes of long duration.

The most commonly grown bean is forastero, a large group of wild and cultivated cacaos, most likely native to the Amazon basin. The African cocoa crop is entirely of the forastero variety. They are significantly hardier and of higher yield than criollo. The source of most chocolate marketed, forastero cocoas are typically strong in classic “chocolate” flavor, but have a short duration and are unsupported by secondary flavors, producing “quite bland” chocolate.

Trinitario is a natural hybrid of criollo and forastero. Trinitario originated in Trinidad after an introduction of forastero to the local criollo crop. Nearly all cacao produced over the past five decades is of the forastero or lower-grade trinitario varieties.

Chocolate is very sensitive to temperature and humidity. Ideal storage temperatures are between 15 and 17 °C (59 and 63 °F), with a relative humidity of less than 50%. Various types of “blooming” effects can occur if chocolate is stored or served improperly. Fat bloom is caused by storage temperature fluctuating or exceeding 24 C while sugar bloom is caused by temperature below 15 C or excess humidity. To distinguish between different types of bloom, one can rub the surface of the chocolate lightly, and if the bloom disappears, it is fat bloom. One can get rid of bloom by re-tempering the chocolate or using it for anything that requires melting the chocolate.

Chocolate is generally stored away from other foods, as it can absorb different aromas. Ideally, chocolates are packed or wrapped, and placed in proper storage with the correct humidity and temperature. Additionally, chocolate is frequently stored in a dark place or protected from light by wrapping paper.

If refrigerated or frozen without containment, chocolate can absorb enough moisture to cause a whitish discoloration, the result of fat or sugar crystals rising to the surface. Moving chocolate from one temperature extreme to another, such as from a refrigerator on a hot day, can result in an oily texture. Although visually unappealing, chocolate suffering from bloom is perfectly safe for consumption.

Some manufacturers provide the percentage of chocolate in a finished chocolate confection as a label quoting percentage of “cocoa” or “cacao”. It should be noted that this refers to the combined percentage of both cocoa solids and cocoa butter in the bar, not just the percentage of cocoa solids.

Chocolates that are organic or fair trade certified carry labels accordingly.

In the United States, some large chocolate manufacturers lobbied the federal government to permit confections containing cheaper hydrogenated vegetable oil in place of cocoa butter to be sold as “chocolate”. In June 2007, as a response to consumer concern after the proposed change, the FDA reiterated “Cacao fat, as one of the signature characteristics of the product, will remain a principal component of standardized chocolate.”

Many chocolate manufacturers have created products from chocolate bars to fudge, hoping to attract more consumers with each

A Hershey chocolate bar

creation. Hershey and Mars have become the largest manufacturers in the world. Other large manufacturers include Nestlé, Kraft Foods and Lindt.

The Hershey Company, known for their Hershey bar, Hershey’s Kisses and Reese’s Peanut Butter Cups, is the largest chocolate manufacturer in North America. Mars, Incorporated, one of the largest privately owned U.S. corporations, is a worldwide manufacturer of confectionery and other food products, with US$21 billion in annual sales in 2006. Mars is known for Mars Bar, Milky Way, M&M’s, Twix and Snickers, as well as other confectionery items, such Skittles.

Food conglomerates Nestlé SA and Kraft Foods both have chocolate brands. Nestlé acquired Rowntree’s in 1988 and now market chocolates under their own brand, including Smarties and Kit Kat; Kraft Foods through its 1990 acquisition of Jacobs Suchard, now own Milka and Suchard. In February 2010, Kraft also acquired British-based Cadbury plc, the world’s largest confectionery manufacturer. Cadbury is well known for its Dairy Milk range and Creme Egg; Fry’s, Trebor Basset, the fair-trade brand Green & Black’s also belong to the group.

The chocolate industry, a steadily growing, $50 billion-a-year worldwide business centered on the sale and consumption of chocolate, is prevalent on five out of seven continents. Big Chocolate, as it is also called, is essentially an oligopoly between major international chocolate companies in Europe and the U.S. These U.S. companies, such as Mars and Hershey’s alone, generate $13 billion a year in chocolate sales and account for two-thirds of U.S. manufacturers. However, Europe accounts for 45% of the world’s chocolate revenue.

Chocolate is one of the most popular holiday gifts. The International Chocolate Day is observed on September 13. On Valentine’s Day, a box of chocolates is traditional, usually presented with flowers and a greeting card. It may be given on other holidays, and birthdays. At Easter, chocolate eggs are traditional. This is a confectionery made primarily of chocolate, and can either be solid, hollow, or filled with other sweets or fondant. Many confectioners make holiday-specific chocolate candies, usually variants of their standard fare.

Nut of the Week – Pistachios

March 5, 2012 at 10:10 AM | Posted in diabetes, diabetes friendly, Food, low calorie, low carb, nuts | 1 Comment
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Pistacia vera Kerman fruits ripening

The pistachio, Pistacia vera in the Anacardiaceae family, is a small tree originally from Persia (Iran), which now can also be found in regions of Iraq, Syria, Lebanon, Turkey, Greece, Tunisia, Kyrgyzstan, Tajikistan, Turkmenistan, India, Pakistan, Egypt, Sicily, Uzbekistan, Afghanistan, especially in the provinces of Samangan and Badghis, and the United States, specifically in California. The tree produces an important culinary nut.

Pistacia vera often is confused with other species in the genus Pistacia that are also known as pistachio. These species can be distinguished from P. vera by their geographic distributions (in the wild) and their nuts. Their nuts are much smaller, have a strong flavor of turpentine, and have a shell that is not hard.

Pistachio is a desert plant, and is highly tolerant of saline soil. It has been reported to grow well when irrigated with water having 3,000–4,000 ppm of soluble salts. Pistachio trees are fairly hardy in the right conditions, and can survive temperatures ranging between −10°C (14°F) in winter and 40°C (104°F) in summer. They need a sunny position and well-drained soil. Pistachio trees do poorly in conditions of high humidity, and are susceptible to root rot in winter if they get too much water and the soil is not sufficiently free-draining. Long, hot summers are required for proper ripening of the fruit.

The Jylgyndy Forest Reserve, a preserve protecting the native habitat of Pistacia vera groves, is located in the Nooken District of Jalal-Abad Province of Kyrgyzstan.

The bush grows up to 33 ft tall. It has deciduous pinnate leaves 4–8 inches long. The plants are dioecious, with separate male and female trees. The flowers are apetalous and unisexual, and borne in panicles.

The fruit is a drupe, containing an elongated seed, which is the edible portion. The seed, commonly thought of as a nut, is a culinary nut, not a botanical nut. The fruit has a hard, whitish exterior shell. The seed has a mauvish skin and light green flesh, with a distinctive flavor. When the fruit ripens, the shell changes from green to an autumnal yellow/red, and abruptly splits part way open. This is known as dehiscence, and happens with an audible pop. The splitting open is a trait that has been selected by humans. Commercial cultivars vary in how consistently they split open.

Each pistachio tree averages around 50 kg of seeds, or around 50,000, every two years.

The shell of the pistachio is naturally a beige color, but it is sometimes dyed red or green in commercial pistachios. Originally, dye was applied by importers to hide stains on the shells caused when the nuts were picked by hand. Most pistachios are now picked by machine and the shells remain unstained, making dyeing unnecessary except to meet ingrained consumer expectations. Roasted pistachio nuts can be artificially turned red if they are marinated prior to roasting in a salt and strawberry marinade, or salt and citrus salts.

Like other members of the Anacardiaceae family (which includes poison ivy, sumac, mango, and cashew), pistachios contain urushiol, an irritant that can cause allergic reactions.

Iran, Iraq and Tunisia are the major producers of pistachios. The trees are planted in orchards, and take approximately seven to ten years to reach significant production. Production is alternate bearing or biennial bearing, meaning the harvest is heavier in alternate years. Peak production is reached at approximately 20 years. Trees are usually pruned to size to make the harvest easier. One male tree produces enough pollen for eight to twelve nut-bearing females. Harvesting in the United States and in Greece is often accomplished by using shaking equipment to shake the nuts off the tree. After hulling and drying, pistachios are sorted according to open mouth and closed mouth shell. Sun drying has been found to be the best method of drying. Then they are roasted or processed by special machines to produce pistachio kernels.

The kernels are often eaten whole, either fresh or roasted and salted, and are also used in ice cream, pistachio butter, pistachio paste[18] and confections such as baklava, pistachio chocolate, pistachio halva or biscotti and cold cuts such as mortadella. Americans make pistachio salad, which includes fresh pistachios or pistachio pudding, whipped cream, canned fruit and sometimes cottage cheese. In July 2003, the Food and Drug Administration (FDA) approved the first qualified health claim specific to nuts lowering the risk of heart disease: “Scientific evidence suggests but does not prove that eating 1.5 ounces (42.5g) per day of most nuts, such as pistachios, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease”.

China is the top pistachio consumer worldwide with annual consumption of 80,000 tons, while the United States consumes 45,000 tons. Russia (with consumption of 15,000 tons) and India (with consumption of 10,000 tons) are in the third and fourth places.

In research at Pennsylvania State University, pistachios in particular significantly reduced levels of low-density lipoprotein (LDL cholesterol) while increasing antioxidant levels in the serum of volunteers. In rats, consumption of pistachios as 20% of daily caloric intake increased beneficial high-density lipoprotein (HDL cholesterol) without lowering LDL cholesterol, and while reducing LDL oxidation.

Consuming unsalted, dry roasted pistachios prevents any addition of unwanted fats and additional sodium in the diet that may affect cardiac health adversely and increase hypertension.

Human studies have shown that 32-63 grams per day of pistachio nut can significantly elevate plasma levels of lutein, alpha-carotene, beta-carotene, and gamma-tocopherol.

In December 2008, Dr. James Painter, a behavioral eating expert, professor and chair of School of Family and Consumer Sciences at Eastern Illinois University, described the Pistachio Principle. The Pistachio Principle describes methods of “fooling” one’s body into eating less. One example used is that the act of shelling and eating pistachios one by one slows one’s consumption, allowing one to feel full faster after having eaten less.

The empty pistachio shells are useful for recycling in several ways. If unsalted, the shells need not be washed and dried before reuse, but washing is simple if that is not the case. Practical uses include as a fire starter just as kindling would be used with crumpled paper; to line the bottom of pots containing houseplants for drainage and retention of soil for up to two years; as a mulch for shrubs and plants that require acid soils; as a medium for orchids; and as an addition to a compost pile designed for wood items that take longer to decompose than leafy materials, taking up to a year for pistachio shells to decompose unless soil is added to the mix. Many craft uses for the shells include, holiday tree ornaments, jewelry, mosaics, and rattles. Scientific research indicates that pistachio shells may be helpful in cleaning up pollution created by mercury emissions.

New and Improved Diabetes Medications

October 14, 2011 at 12:31 PM | Posted in diabetes, diabetes friendly, Food, fruits, low calorie, low carb, vegetables | 1 Comment
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Having diabetes 2 I’m always trying to keep up on all the news on diabetes and ran across this article from web site and thought I would pass it along.

Pharmacy shelves and the approval pipeline are packed with new medications for all types of diabetes, according to our experts.

By Hope S. Warshaw, R.D., CDE

“Efforts to develop and approve blood glucose-lowering medicines for type 2 diabetes are at an unprecedented high,” says Kelly L. Close, PWD type 1, president of Close Concerns, Inc., a health care information company, and editor-in-chief of e-newsletter diaTribe ( “No surprise — so are the numbers of people with type 2 and the need for new therapies.”

Overview of the most significant symptoms of diabetes.

The need, the numbers, and the understanding that type 2 is more than just a glucose and insulin problem have revved the drug-development engines, with some likely benefits for type 1 diabetes, too. “We now know that six or more organs are involved in glucose control, including the pancreas, liver, gastrointestinal tract, muscle, adipose tissue (fat), and brain,” says Susan Cornell, Pharm.D., CDE, assistant professor of pharmacy practice at Midwestern University Chicago College of Pharmacy in Downers Grove, Illinois.

Cycloset, the first in a new class of drugs, is a pill containing quick-release bromocriptine mesylate. Approved by the U.S. Food and Drug Administration in 2009, it’s just making its way onto drugstore shelves. The pill, taken once a day within two hours of waking, restores the brain-based hormone dopamine to normal activity by resetting your circadian rhythm. This action lowers blood glucose. It was the first blood glucose-lowering drug to clear the FDA hurdle requiring more studies to ensure heart safety.

U-500 insulin, which has been available for years, is getting second looks. It’s five times more concentrated than the common U-100 type. Experts are experimenting with U-500 for people who need large amounts of insulin by injections or a pump, such as those who are overweight and/or have significant insulin resistance. Red flags, according to Laura Shane-McWhorter, Pharm.D., CDE, professor of pharmacotherapy at University of Utah College of Pharmacy in Salt Lake City, are its longer action time and concentration, both of which can cause dosing confusion. She advocates a treatment plan that details ways to respond if too much U-500 insulin is given mistakenly.

Incretin mimetic liraglutide (Victoza) adds one more drug to this class of injectables, also known as GLP-1 analogs. They stimulate insulin output, decrease glucagon output, and lower after-meal glucose rise. By doing so, these drugs decrease appetite and food intake. To date they have the best track record of any blood glucose-lowering drug in helping people with type 2 trim pounds. Victoza’s virtue? It’s taken once a day. (Byetta, taken twice a day, has been available for several years.) You’re likely to see more drugs in this class and approval from the FDA for their use with basal insulin. (New uses for already-approved drugs require additional studies and approval.)

DPP-4 inhibitor saxagliptin (Onglyza) is the second entry in this class; sitagliptin (Januvia) was first. You’ll recognize this class of pills by the common “gliptin” suffix. These drugs work on the gut by slowing the breakdown of the DPP-4 enzyme, which in turn slows the rate at which food speeds through the gastrointestinal tract. The actions of DPP-4 inhibitors are similar to incretin mimetics but don’t have quite the oomph in blood glucose-lowering power and weight loss.

Also new is Kombiglyze, the first DPP-4 inhibitor combination drug. It contains saxagliptin and extended-release metformin.

Sodium-glucose transporter 2 (SGLT-2) inhibitors would be the first drug class to target blood glucose-lowering action on the kidneys. Several are nearing the FDA finish line, and others are in companies’ pipelines. Their common suffix is “gliflozin,” with full names such as dapagliflozin and canagliflozin. SGLT-2 inhibitors block a transporter protein that returns glucose to the bloodstream after it’s filtered through the kidneys. Blocking this protein causes more glucose to be flushed out in the urine. On their own the medicines don’t cause low blood sugar (hypoglycemia) or weight gain. The SGLT-2 inhibitors are likely candidates for combo drugs and also may be useful in treating type 1 diabetes, Close says.

DPP-4 inhibitors alogliptin and linagliptin (Tradjenta) may be approved before the year’s end. Linagliptin is the first DPP-4 inhibitor with a twist — it’s cleared from the body mainly through the liver, not through the kidneys. This is a plus because about 40 percent of PWDs, especially people with high blood pressure and 10 years or more of diabetes, are estimated to have chronic kidney disease.

Extended-release exenatide (Bydureon), an incretin mimetic, was poised for approval at the end of 2010, but the FDA requested more information and an additional study related to its safety for the heart. The exciting plus of Bydureon: just one weekly injection.

Fast-acting insulins fill a need in both type 1 and type 2 diabetes because the available rapid-acting insulins aren’t fast enough to control postmeal blood glucose rise. To this end, MannKind has been trying to get inhalable Afrezza on the market. The FDA, however, has again requested additional studies of this nasal insulin delivered through a fits-in-your-hand inhaler device. It’s designed to be taken before meals to lower blood glucose immediately after eating — a fast start and quick finish hold the promise of reducing hypoglycemia. Afrezza, if approved, would be paired with an injectable long-acting insulin or other long-acting medicine. Another fast-acting insulin sent back to the drawing board by the FDA is Linjeta (formerly called VIAject).

Long-acting basal insulin, the insulin that regulates blood glucose between meals and overnight, is the focus of new formulations at the three major worldwide insulin manufacturers. Novo Nordisk may be closest to the finish line with Degludec, as well as a concentrated U-200 formulation for people taking more than 80 units a day. Sanofi-aventis is working on technology to reduce injection frequency, and Lilly is working on two basal insulins.

At diagnosis, PWDs type 2 have, at best, just half of their dwindling insulin-making pancreatic beta cells left, says Richard Bergenstal, M.D., executive director of the International Diabetes Center at Park Nicollet in Minneapolis. Aggressively preserving your remaining beta cells is key for glucose control. (Currently, we don’t have a way to halt the autoimmune attack on beta cells and preserve them in type 1 diabetes.) Here’s how to take control:

Talk to your provider about the best starting drug for you. Most guidelines suggest starting with a low dose of metformin, which decreases insulin resistance and improves fasting blood glucose.
Ask about next steps. If you don’t hit your glucose and A1C targets in 2-3 months, your provider should progress your amount and/or type of medicine.
Do your best to follow a healthful eating plan and to be physically active. Glucose-lowering medicines work best meshed with a healthful lifestyle. You may be able to take lower doses of fewer meds over the years. Plus, you’ll feel better, Cornell says.

Hope Warshaw, R.D., CDE, coauthor of Real-Life Guide to Diabetes (American Diabetes Association, 2010) is a Diabetic Living contributing editor.

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