Talk:Diabetes mellitus/Archive 5

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latin american ethnicity?[edit]

what does it mean? Afrobrazilians? German brazilians? Italian Argentines?? native Bolivians? mestizo Mexicans????

Latin american ethnicity is like said North American ethnicity. hispanic/latin american can be of any race.

I changed it for mestizos and native american (that is what the person who wrote that meant.

Objections to diabetes mellitus article[edit]

From my (User:Karada's) talk page:

Hello Karada,
You asked about diabetes mellitus article and my objections to its content.
First, it is of patchy quality. There are passages or section that are quite acceptable and other that need major rewrite.
Second, its style is inconsistent. Sometimes it uses scintific language and nomenclature and sometimes it is written in badly conceived "for patients" style. (I once proposed to make corresponding "Patient information" pages in this case "Patient information on Diabetes mellitus" linked to the scientific article Diabetes mellitus)
Third, see sections Diabetes mellitus#Diabetes treatment. Current standards - St Vincent declaration.
Presentation is also lacking and diabetic ketoacidosis is insufficient.
My ideal for a medical article would be a well researched, well referenced, scientific language, readable and state-of-the-art body of information.

Kpjas 06:53, 24 Sep 2003 (UTC)

I've had Type I diabetes for 12 years now and looked up what Wikipedia has to say about diabetes just out of interest. The facts seem okay here, but I find the approach really depressing. If one of my friends wanted to find out more about my diabetes, I wouldn't want the list of possible complications to be the first thing they see. I guess something like the "Patient Information" pages proposed above are what I would want. Something that would bring out that people with diabetes CAN live a long, happy and meaningful life, have healthy children, be successful in their studies and careers and so on. This obviously requires good medical treatment and high motivation but is still feasible. This article (and other related pages, eg. Diabetes mellitus type 1) gives no idea whatsoever of what living with diabetes means to the patient. Having diabetes is a burden but not something that keeps me from doing the things I want.
Thus (after excessive whining ;) here's a few thoughts on how to develop this site:

  1. Add a section about living with diabetes. (Or "What you need to know about your friend's diabetes" or something equally stupid-sounding ;) When I tell people that I'm diabetic, the most common questions are "Can you eat sugar / What can you eat?", "How many times a day do you take injections?" and "What can make you feel bad and how can I help with that?". I think it would be a good idea to tell basic stuff about what to do in case of hypo- and hyperglycaemia, what kinds of food diabetics can eat (many people fail to believe that eating sugar occasionally is totally okay), what affects how much and how often insulin has to be taken, and something about different kinds of insulin. The last points are covered to some extent in Intensive insulinotherapy, but I think there should be a general idea of this on the main page as well (or the "Patient Information" page, or whatever it will be called).
  2. The List of celebrities with diabetes is not enough to bring out that diabetes doesn't prevent people from living a good life. The only professions strictly forbidden from diabetics these days are, as far as I know, driving public transport vehicles and diving. There are firemen and ambulance doctors with diabetes. For the past couple of years, diabetics in Finland have even been allowed to go to the army if they want. So I think it would be nice to bring out, either in the section suggested above or somewhere else, that with good treatment and motivation, a person with diabetes is able to have almost any job, live a fairly normal and healthy life and have children. Employers shouldn't feel doubtful about whether they can safely hire a diabetic and friends or teachers shouldn't fuss and worry more than they need. If they are provided with only this kind of information, they will and do.
  3. Since I brought up the issue of children here, I think it's worth noting somewhere that the risk that the children of a diabetic get diabetes is pretty low (see eg. Hanas, Ragnar: Type 1 Diabetes in Children, Adolescents and Young Adults; Class Publishing, London 2005 - it has good references). Also, diabetic women can have children as long as their blood glucose level is reasonably good and they haven't developed complications.
  4. I think the data about how many diabetics have a first-degree relative with diabetes is generally interesting, as is data about the incidence of diabetes in different countries. More info about type 1 in Diabetes#Genetics, please, and be more specific about type 1 incidence in Diabetes#Statistics or in Diabetes mellitus type 1.
  5. There's a lot of ideas and research about the causes of diabetes. Diabetes#Causes and types could and should be expanded and improved. I think it would be relevant to diabetics ("Why did this happen to me?") as well as for the general audience. Saara, 12 November 2005

The author of the above points may like to know that there are cases of diabetics who have lived to be 100. Obviously, to achieve this, diabetics have to look after their health carefully.ACEO 20:25, 15 March 2006 (UTC)

Every single point you offer is accurate and excellent. I think we all agree this is an article with a long way to go. alteripse 19:31, 12 November 2005 (UTC) Tje

The intro does need to mention the main complications, however gruesome they may sound to a newly diagnosed diabetic. JFW | T@lk 21:30, 12 November 2005 (UTC)

The point is that "Complications of Diabetes" is not the whole point of the article. Although they should certaintly be mentioned in the article somewhere, they should not neccessarilly be first. I have had type-1 diabetes for 11 years; I find it akin to insulting that there is hardly mention of how diabetics can lead normal lives in this article. There's more to diabetes than complications. --Kormerant 03:35, 9 July 2006 (UTC)

The right balance and tone for an article like this is often a matter of contention. I don't think anyone could disagree that chronic complications are one of the 5 most important facts about both types of diabetes (thereby deserving mention in the introductory paragraph). Likewise all would agree that one of the key goals of management is to keep diabetes from interfering with the worthwhile aspects of life. However, a lot of people with diabetes would argue with you that neither (a) the daily work & pricks to maintain sort-of normal glucose levels or (b) trying to pretend you don't have diabetes and eventually facing the consequences is accurately described as "leading a normal life". I do know what you meant and agree with you, but do you see how tricky the tone and choice of words becomes? Your participation and suggestions are welcome. alteripse 19:38, 9 July 2006 (UTC)
Concur entirely with Alteripse (got it that time!!) on this point. It's annoying and worse to have to constantly consider all this nuisance, it marks one aside from the regular folk, and much of the concern must be for the future (either a few days down the road (eg, DKA) or some years down the road (long term complications), something humans aren't all that good at. Nonetheless, until cures are avaialble, exactly those things are obligatory except in those who would not object to DKA or an amputation or two or .... Groucho said it best, though not re membership in the fraternity of diabetics. ww 19:59, 9 July 2006 (UTC)

Curing Diabetes - Revision?[edit]

A disease consisting of the failure of a single organ (type 1 diabetes, the Islets of Langerhans) with a relatively simple function, points at the cure. Type 2 diabetes is more complex and difficult, but increasing physical activity and correcting body mass may be very helpful.

Could this be revised a bit? From what i know, it seems completely wrong, its implying Type 1 is not anymore complex than the failure of a single organ, when its not so much the failure, but the immune attack on that part of the pancreas caused by an unknown event/gene..

I agree that this paragraph makes some fairly wild conjenctures. There are many diseases of one organ that cannot be cured just that easily. With respect to curing type II DM, we'll first need to find out what the causative mechanism actually is before we can dream of curing it. JFW | T@lk 05:53, 12 March 2006 (UTC)

...but it is not the failure of a single organ, as only one of the cell types of that organ are deficient --DR Congo 19:59, 30 July 2006 (UTC)

Links to Katy Harris article[edit]

There are, in Wikipedia, articles on Katy Harris and Coronation Street. As this programme has a wide audience in the United Kingdom, perhaps this article should establish wiki-links with these articles. Katy was diabetic, and for many people, the representation of Katy in this programme will represent their public knowledge and understanding of diabetes. It would be good if, having established a wiki-link to the Katy Harris article, medical authorities could give their verdict on how accurate the information conveyed in this programme was. ACEO 18:52, 10 May 2006 (UTC)

The links suggested are best made from the Katy Harris and Coronation Street articles. They are, after all, fictional, however popular and so incidental to a factual article (insofar as we can manage) on a disease. A comment on the diabetic accuracy and context of the information in the katy Harris article can be found in Talk:Kay Harris. Does it help? ww 16:57, 14 May 2006 (UTC)

viral diabetes merge[edit]

I'm inclined to oppose for the following reasons. This ia already a large article of first resort. It should be written for the Average Reader, leaving detailed coverage of special topics like this to their own articles. The connection is already mentioned, in any case. Comments? Thoughts? ww 21:22, 4 June 2006 (UTC)

I proposed b/c I found it during new page patrolling and thought someone had mistakenly made a page duplicating the content here. Sorry. Should have read more carefully. It just seemed bizarre that we wouldn't already have a page on the topic. Anyway, whatever you all think is best. --Kchase02 (T) 22:45, 4 June 2006 (UTC)
I'm failing to see why a merge is needed... Although the Viral Diabetes article isn't of the highest quality, a rewrite by someone who understand the topic should suffice. --Mechcozmo 04:52, 5 June 2006 (UTC)
OK, I'll remove the merger tags. Thanks for your input. Viral diabetes. --Kchase02 (T) 05:14, 5 June 2006 (UTC)

The viral diabetes article should be deleted. It's pretty much nonsense. InvictaHOG 10:44, 5 June 2006 (UTC)

Big edit[edit]

I've done quite a lot of slashing. Apologies to those whose work may have been moved to subpages. But I think it's clearer now. JFW | T@lk 00:10, 7 July 2006 (UTC)

The following references were listed but were not referenced to in the article. I'm moving them here for perusal by other editors, but I don't think they should just stay there:

  • "The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group". N Engl J Med. 329 (14): 977–86. 1993. PMID 8366922. 
  • "Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group". Lancet. 352 (9131): 837–53. 1998. PMID [ Abstract 9742976 [ Abstract]] Check |pmid= value (help). 
  • Ruth A. Hansen and Ben Atchison, ed. (2000). Conditions in Occupational Therapy: effect on occupational performance. Baltimore: Lippincott Williams & Williams. pp. 298–309. ISBN 0-683-30417-8. 
  • Collins R, Armitage J, Parish S, Sleigh P, Peto R, Heart Protection Study Collaborative Group (2003). "MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial". Lancet. 361 (9374): 2005–16. PMID 12814710. 
  • Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH (2004). "Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial". Lancet. 364 (9435): 685–96. PMID 15325833. 
  • "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial". Lancet. 360 (9326): 7–22. 2002. PMID 12114036. 
  • Underwood, Anne (January 16, 2006). "Super Nutrients: Chromium "may help diabetic and pre-diabetic patients boost their insulin sensitivity"". Living Longer, Better. Newsweek. Retrieved 2006-03-17. 

I suspect many of them belong to the management of diabetes article rather than here. JFW | T@lk 07:44, 7 July 2006 (UTC)

Curing diabetes[edit]

"A disease consisting of the failure of a single organ with a relatively simple function has led to the study of several possible schemes to cure diabetes."

Surely that isn't the reason that people are looking for cures?

I would re-write this myself but I don't know anything except for the recent stuff with Richard Lane[1]. AlistairMcMillan 21:01, 9 July 2006 (UTC)

We stumble over each other again. Haunting me, are you? I think the point of this phrase is rather lost in the obscure wording. It's something like, this is a simple disease so it should be easy to develop a cure for, unlike osteoporosis which is bone wide and due, apparently, to a mass of mutually balancing tendencies. probably should be rewritten if it's readable this way... ww 21:25, 9 July 2006 (UTC)
Isn't that the only way to read it... X had led to Y. Maybe it is supposed to be something the "The disease, consisting of the failure of a single organ with a relatively simple function, has led to the study of several possible schemes to cure diabetes." AlistairMcMillan 21:52, 9 July 2006 (UTC)

I wish you wouldn't immediately slap tags on an otherwise quite heavily referenced article. Give the longterm editors a sporting chance to find useful sources. It would be much more useful if you actually attempted to rewrite the sentence in question. JFW | T@lk 07:27, 10 July 2006 (UTC)

Curing type 1: PMID 15647717 (despite the title only covers type 1)
Curing type 2: PMID 12409659 (a rather over-hyped title for such a modest study) JFW | T@lk 07:34, 10 July 2006 (UTC)

GTF -- to include or not to include, that is this question[edit]

Xemxija (talk · contribs) wants the intro to state that diabetes is due to "either from inadequate secretion or action of the hormone insulin, an inadequate response by the body's cells to insulin, or a combination of these factors." The insertion of the - in my view redundant - words "or action" is supported by the argument that "cells" does't include GTF. Now I presume we're talking about "glucose tolerance factor", an organified form of chromium that has been extracted mainly from yeast. There is no clinical evidence that chromium levels influence glycaemia and insulin resistance in human studies, so I don't think this should be covered in the intro at all, or even in the whole article for that matter. JFW | T@lk 07:48, 19 July 2006 (UTC)

GTF is a far more complex structure than "an organified form of chromium". Chromium doesnot constitute ven 5% of its structure. There is far more concerning it than one citation in PubMed. --JohnMurphy 12:35, 19 July 2006 (UTC)

But this is an exogenous substance derived from yeast. How can you possibly link that to pathophysiology in humans? JFW | T@lk 13:18, 19 July 2006 (UTC)

I fully agree with JFW. Where are the references? Also: insulin acts on cells, not on GTF. According to the presumed mechanism, GTF does not interact with insulin itself; if anything, it "modulates the response of cells to insulin". See: Davis CM, Sumrall KH, Vincent, 1996, "A biologically active form of chromium may activate a membrane phosphotyrosine phosphatase (PTP)." JB Biochemistry. 35(39):12963-9. GTF does not cause diabetes.   Andreas   (T) 14:06, 19 July 2006 (UTC)

1. Insulin acts via GTF in order to attach it to cells. There are far more references involved than could ever be provided here. In order to obtain a knowledge of insulin biochemistry you would have to study advanced biochemistry.

2. It is only derived from yeast for experimental purposes.

3. The study you refer to is only one study and is ten years out of date anyway.

--JohnMurphy 14:14, 19 July 2006 (UTC)

" There are far more references involved than could ever be provided here." It is official Wikipedia policy to provide sources, see Wikipedia:Verifiability: "Information on Wikipedia must be reliable. Facts, viewpoints, theories, and arguments may only be included in articles if they have already been published by reliable and reputable sources. Articles should cite these sources whenever possible. Any unsourced material may be challenged and removed." If there are so many references on this subject (that I couldn't find), then please show them here.
"advanced biochemistry": the credentials of the editors should be irrelevant here, but you might want to consult my user page.   Andreas   (T) 15:03, 19 July 2006 (UTC)

Your suggestion is completely contrary to current knowledge of anyone that has studied insulin biochemistry. Therefore, according to Wikipedia policy you will have to provide sources to show that insulin attaches directly to the cells, because that is what you are claiming. At present it remains unverified and contrary to common knowledge within insulin biochemistry. --JohnMurphy 15:25, 19 July 2006 (UTC)

GTF is used as a nutritional supplement with an alternative backing[2]. Searching PubMed for glucose tolerance factor yields 76 results, not quite a heavily researched subject compared to other diabetes-related topics. The only recent reference is from 2006, which refers to GTF as "an oral antidiabetic material extracted from yeast" (PMID 16565236). There were none in 2005, then a smattering in the preceding years. All refer to this as a chrome-containing yeast substance, and many reports suggest the chrome content potentiates the action of insulin. The only reference that seems to suggest a GTF in humans is PMID 7268774, published in 1981, and PMID 7005627, published in 1980.
I hotly dispute the assertion that only trained biochemists are allowed to make assertions on the action of insulin. This is easily verified with widely available resources, and the role of chromium is far from established here. In fact, it is so unestablished that I would not support a mention of this phenomenon in the article intro.
I will crosspost on WP:CLINMED to see if my esteemed colleagues have any further information. JFW | T@lk 17:23, 19 July 2006 (UTC)
Gentlemen: AHHMMMM!
WP's verification policy is not optional for one side or the other, regardless of what's 'generally understood'. It is an official WP policy -- one of three IIRC. Everyone is supposed to provide a way for a reader to check a fact (interpretation, idea origin, ... <whatever the article's about>) on WP. Another WP policy (also an official one) is 'no original research'. WP is a reporting mechanism for existing knowledge (that being defined as verifiable -- NOT as being 'true' by some standard -- there are so many, sigh!). Thus, none of the various sides here is correct.
An old study easily to hand may have been since shown to be wrong, in which case it's the obligation of the objector to show that by noting another, later, quality study. The assertion, especially as an objection to another's posiiton, that "everyone knows" (or "too many sources to cite") is simply not on for WP. Objections as to any assertion should be met by pointing to at least one respectable source.
Now, all that said, there are indeed questions about what source is 'respectable'. There is so much wondrous choice, more than a little of it a modern Baron Munchausen's fantasy. Especially in re DM, where the quackery is, and has been forever it seems, pervasive. Ancient cures known only to the Inner Franistanilobians or some such, maybe. Or recently discovered stuff by Prof Marx in Freedonia. And none known to ordinary diabetes groups (eg, ADA or equivalent elsewhere), research organizations (eg, NIH or equivalents elsewhere), or clinicians (eg, the Joslin Clinic folks or perhaps your own MD if up to following the frustrating ramified maze that is DM). Recall that DM related research has won 5 Nobels to date (Banting, Best, Sanger, Hodkgins, Yallow), and anyone with a cure will necessarily be generating a tremendous amount of buzz. Only conspiracy theories of one sort of another can account for the otherwise unaccountable lack of recognition of <insert your favoite obscure treatment/cure here>. That, or it's bunkum.
While a WP article on DM bunkum would be entirely appropriate, and doesn't yet exist to my knowledge, I suspect one is not likely for human psychology reasons. Until then, this article is not about such, and if something can't be verified according to official policy, it sholdn't be here, except as a brief sidenote exemplifying possible fraud. (See insulin at the terminal section discussing athletes' use/misuse and reports thereof in the public press).
Thus, to quote Mr King, "Can't we just get along?". ww 17:19, 19 July 2006 (UTC)

The fact that some forms of GTF are derived from yeast or anywhere else is irrelevant. Most vitamins are derived from yeast, yet you wouldn't claim that vitamins don't exist in humans !

Chromium's only function in humans is in the action of insulin, as part of what is commonly called GTF. Time and time again Chromium has been shown to reduce insulin resistance e.g. Folia Med (Plovdiv). 2005;47(3-4):59-62 "Effect of chromium on the insulin resistance in patients with type II diabetes mellitus." It can not do this by any other means than besides facilitating insulin action.

--JohnMurphy 17:47, 19 July 2006 (UTC)

We are discussing here the inclusion of the word "action" into the opening paragraph. Irrespective of the GTF issue, this word is superfluous. I have no clue what a putative binding of insulin to the cell surface and interference of this by GTF has to do with the causes of diabetes. Is there evidence that diabetes is caused by lack of GTF? If so, where are the sources/references? And if it were so, then the lack of GTF would still "modulate the response of cells to insulin" by interfering with binding. "Action" implies "modulate the response of cells to insulin" and therefore inclusion of the term is a pleonasm to be avoided. What would be an action that does not modulate the response of cells to insulin, and how would such an action relate to the causes of diabetes? And, is GTF mentioned somewhere on Wikipedia?   Andreas   (T) 17:59, 19 July 2006 (UTC)

Insulin attaches via the sulfur on its cysteine residues to a complex commonly called GTF by laymen or Tetra-Aquo-Dinicotinato Chromium complex, which consists of Chromium, molecules of Nicotinamide, and 4 of H20. GTF or TAD complex attaches to the cell membranes also via the sulfur on its cysteine residues. Glutathione is also required for this process. Therefore, if GTF were not biosynthesized, insulin could not act on the cell membranes.

1. Chromium's only function in humans is in the formation of GTF. It does nothing else.

2. Chromium can not be acting alone because it does not have the means of attaching proteins (such as insulin and cell memebranes)to each other.

3. Therefore evidence, of which there is an abundance, that chromium leseens insulin resistance or lowers blood glucose levels means that the Chromium complex (GTF) must be facilitating insulin action.

Therefore, it isnot just a matter of the formation of insulin, the action of that insulin (via the Chromium complex)is also needed.

--JohnMurphy 18:20, 19 July 2006 (UTC)

JM, This is fascinating material on a clearly outlined mechanism and entirely new to me. I would dearly love to see references for it, and if they exist that it be included in WP if not in this detail in this article of first resort. But, I note that the academics and clinicians are dubious (we have one of each in the immediately preceding) about it and so I am leery. Is there anything (save the copious sales pointers I get from Google) on this mechanism? All the references I've seen have been of the "small number of patients tried this stuff, some got better, might be significant, but who knows how?" sort. Please enlighten me at least, if not this precise article! ww 18:51, 19 July 2006 (UTC)

I am certainly not proposing the use of GTP as a therapeutic tool, regardless of what positive claims might be made for it. As GTF is a complex of several substances it will inevitably break up as it enters the body in to its various constituents, after which it will not actually be GTF any longer. Somebody would be better taking chromium so that the body can form its own GTF.

I am merely stating the biochemical mechanism in humans as it presently appears to be according to a combination of biochemical studies. All relevant studies such as chromium v insulin resistance are consistent with the biochemical mechanism described, as they consistently show that chromium facilitates insulin function. I will add the full details to WP at some point, although given that diagrams are by far the best way to explain this mechanism I'm not sure how I am going to achieve it as my technical knowledge of the WP functionsis remarkably limited.

There are other major biochemical omissions on the diabetes page. For example, that essential for the secretion of insulin is the formation of zinc-insulin, which is why zinc levels can affect blood glucose levels.

--JohnMurphy 19:13, 19 July 2006 (UTC)

Most of what you are referring to is a rather non-standard approach, and Rok Bura is being a bit outlandish when he puts the onus of proof on other editors that insulin binding to the insulin receptor is direct (I thought it was, and do not understand his point).
I also fail to understand how we should take your word for it when it comes to the inclusion of "and action" in the complete absence of reliable sources that support your position. What I would like is a study (biochemical or clinical) showing a strong relationship between chromium and insulin action.
At the moment the impression I'm getting is one of an orthomolecular theory that has failed to achieve acceptance in the mainstream medical community. Am I correct here? JFW | T@lk 20:19, 19 July 2006 (UTC)
Googling for "insulin" + "TAD complex" gives an abysmally low number of results. The TAD complex is mentioned with respect to phosphorylation and HPV11, but not with insulin. Googling for "TAD complex" + "chromium" gives no hits at all. Unfortunately PubMed is down, but Google indexes PubMed very well. JFW | T@lk 20:29, 19 July 2006 (UTC)
It seems PMID 9356027 will answer our question to a degree. That still does not mean that low chromium levels are automatically associated with disease, and I expect a reference for that. JFW | T@lk 20:32, 19 July 2006 (UTC)
And the resources I have found suggest it is not insulin-receptor binding but the intracellular tyrosine phosphorylation that is linked to both chromium and possibly TAD. What point could Rok Bura be making? JFW | T@lk 20:40, 19 July 2006 (UTC)

What a long discussion for one word! Again: could somebody tell me the difference in meaning between "inadequate action of insulin" and "inadequate response by the body's cells to insulin"? I thought the action of insulin is to induce a response of the cells. I do not see what this has to do with chromium.   Andreas   (T) 22:21, 19 July 2006 (UTC)

Given the evidence I have found with only light searching, there is no grounds to include the disputed few words. You may think the discussion is excessive, but this is actually very important: what importance do we attach to the reports alluded to by Xemxija, JohnMurphy and Rok Bura? Why are Xemxija and Rok Bura not participating in this discussion but simply reinserting the same few words? Why have three new editors suddenly descended on this article to emphasise this point? JFW | T@lk 09:19, 20 July 2006 (UTC)

1. GTF facilitates the action of insulin on the cells. Even the study conffirms it that you yourself refer to which I assume is Biochemistry 1996 Oct 1;35(39):12963-9. "A biologically active form of chromium may activate a membrane phosphotyrosine phosphatase (PTP)." It states that "a biologically active form of chromium in mammals (GTF), potentiates the effect of insulin on the conversion of glucose into lipid and into carbon dioxide in isolated adipocytes." Even a knowledge of basic biochemistry would completely nullify the notion of GTF instead being intracellular, as it requires glutathione for function. Glutathione never enters the cells, nor could GTF due to its size and complexity. Therefore GTF or TAD complex must act outside the cells in the action of insulin rather than the activity of the cells themselves.

2. "Again: could somebody tell me the difference in meaning between "inadequate action of insulin" and "inadequate response by the body's cells to insulin"? Insulin is first biosynthesized, then secreted, then it stimulates the cells via GTF (the action of insulin), then the cells respond to insulin. There is a long sequence of events. Insulin biosynthesis is only one of them. "inadequate action of insulin" means that insulin is not stimulating the cells sufficiently. The fault is outsie the cells. "inadequate response by the body's cells to insulin"? meansthat the fault is inside the cells. So basically it's outside v inside.

3. There are a plentiful quantity of studies besides the one already given demonstrating the relevance of Chromium to Insulin, and as Chromium's only function is in the formation of GTF it can only be acting via this means. The one supposedly opposing study is not opposing at all. Firstly, there is far more to insulin activity than Chromium. It forms only one part of GTF. So it could not be expected to single handedly treat diabetes anyway. The "opposing" study referred to also took obese individuals. Given their likely high carbo intake they would have low levels of insulin due to its constant beed for formation. Lack of activity would occur to low insulin alone regardless of the Chromium / GTF levels. --JohnMurphy 13:07, 20 July 2006 (UTC)

John, please stop bragging about your biochemistry background. On Wikipedia one wins discussions because of arguments, not credentials. Can I also ask you to please stop reinserting your views without achieving consensus on this talkpage?
The Davis article (PMID 8841143) is not accessible fulltext, but the abstract is by no means clear on where this GTF acts. You also don't mention the insulin receptor at all. Do you believe it exists? PMID 15610006 mentions how well the receptor is conserved for the insulin binding site. It makes no mention of the requirement of a cofactor. PMID 11395511 shows the role of insulin on PTP, but surely that is not the main action of insulin!
All this chromium business is nice, but it is not yet holding at the stage where it would be taught in medical schools. Perhaps you could consider discussing it in insulin receptor, but not in the main clinical article about diabetes. JFW | T@lk 15:36, 20 July 2006 (UTC)

The article does not state where chromium/GTF acts. However, basic biochemistry makes its location obvious. --JohnMurphy 15:49, 20 July 2006 (UTC)

"I always thought of diabetes as a relatively quackery-free zone, but I'll have to revise my opinion. Thanks for your comments on Talk:Diabetes mellitus, anyway. JFW | T@lk 17:35, 19 July 2006 (UTC)"

This quote appears to come from my talk page, and was elicted by my post above (well above now), noting that claims unsupported by citation in the approved WP manner should not be included in its articles, and further that there is and has been a lot of snake oil pushed by one or another (including some physicians) apparently for as long as we humans have had a medical profession attempting to distinguish between the useful and the useless. And asking for a lowering of the temperature in the discussion; it didn't work as can be seen.
As such, jfw's comment (above or below) was not directed toward you or any other editor, but noted his surprise (at which I was myself surprised, and left a note saying so) at the amount of quackery in and around diabetes. It is therefore not an accusation of quackery directed at you. Your response is, I think, unwarranted.
The underlying problem which occasions this sort of dispute is not, I think, as you imply (ie, that others are not being willing to see the evident biochemical truth you are presenting) but that deterimining truth (about this or any other biological subject) in a scientific way is quite difficult and there are many 'results' on offer, some much more credible than others. Indeed, some which deserve no credibility whatsoever. We almost never have a clean and clear clarification in the viability of a theory as happened in the case of Spallanani, Redi, Pasteur in the case of spontaneous generation, or in the case of Galileo in respect of imperfections in the heavens and the centrality of position of the Earth, and in the case of phlogiston theory in the cannon boring experiments of Count Rumford, ... Placebo effect, an inability to tightly control all aspects of a study in the case of human subjects, and so on, add a layer of fuzz to the results we do get. There is ALWAYS the chance that something which sound fine at first glance will turn out to a goof, a fraud, or in the case of something being marketed for commercial advantage, snake oil. Recall, if you will the polywater episode, or Koestler's story of the midwife toad, or the whole Lysenko business (though that had overlays of political eidct from the ill-informed), or the recent series of 'revelations' from S Korean cloning research or quantum material research at Bell Labs. The possibility is omnipresent, and to take note of it is not a hostile act. In a more mathematical instance, there is also the famous (infamous) Indiana legislature's almost enactment of the value of pi. Proof is not so readily available as you, I suspect, believe.
It's a kind of scientific mental hygiene. A Listeric precaution, as it were. Up with which the nature of reality forces us all perforce to put.
This is all in aid of pointing out that the implied (or even explicit) accusations below, are out of line here. Good faith is to be presumed by editors of other editors, and disagreement, even ill-informed disagreement as you allege in this case, is NOT evidence of bad faith. Please don't do this again. ww 20:55, 20 July 2006 (UTC)

It is better not to describe other editors as quacks, especially when you are proven to be scientifically wrong, because besides being in breach of Wikipedia rules, it then brings in to question who is the quack. --JohnMurphy 16:03, 20 July 2006 (UTC)

Isn't it also in breach of Wikipedia rules to try to gain superiority in numbers in support of yourself from elsewhere. --JohnMurphy 19:22, 20 July 2006 (UTC) Because that is what you have just done :

Chaps, I'm having a difficult discussion on Talk:Diabetes mellitus on the role of chromium in insulin signalling. One editor there maintains that chromium influences insulin action independently from insulin receptor transduction. Could you kindly weigh in on this discussion. JFW | T@lk 15:45, 20 July 2006 (UTC)

Nothing wrong with above as makes no request to side with one side, and it purely addresses the need for a debate and consensus without any incivility. Looking at the above exchanges, I would agree this has been "a difficult discussion". Sets out your case neutrally with "One editor there maintains that chromium influences insulin action independently from insulin receptor transduction". Seems reasonable to ask those who have indicated a willingness to collaborate on medical topics to offer their opinions on a medical article. I would accept that "weigh in" could have been more tactfully/neutrally worded as "join in".
But you are asserting expertise & additional knowledge on this compared to other editors (de facto the case given that other editors indicate they are unaware of this theory or the research underlying it) and failing, despite repeated requests to WP:Cite from WP:Reliable sources to WP:Verify and support this additional information to the article. "There are far more references involved than could ever be provided here" is not acceptable either in scientific discussion or encyclopaedia construction. I WP:Assume good faith in that you are indeed very well versed in the research (which other editors have been unable to track down), so you should have no difficulty in citing 3 or 4 of the most recent authoritative or confirmatory studies, or topic-summarising review articles. These citations, being from reliable sources, would no doubt cite their own sources. So with a just a few good recent references, a reader could traverse the background studies and articles of this field. From the point of view of constructing an encyclopaedia, merely asserting that GTP is involved (NB whether or not so), remains a personal opinion unless you agree to start citing reliable sources - failure to do so is specifically covered under WP:No original research. The onus is on you to cite for the additional information you wish to add, not on other editors to do this for you.
Not being a trained biochemist (not that that should have any relevance as to whether or not I am able to make some modest contributions to the article), I do not think anyone has even got round to being able to formally state opinions that GTP is one of: a new understanding / a greater understanding of a previously incompletely understood processes / of only secondary importance / wrong / misguided / quackery - for that would first require that you provide the requested references for other editors to make a decision upon.
In short - cite & verify and WP:NPOV will ensure it needs including - otherwise accept it is likely to be deleted on sight (rightly or wrongly) by other editors under WP:NOR. Inform and educate us (I/we don’t know it all) but consensus will not be reached by imposing/lecturing :-) David Ruben Talk 21:08, 20 July 2006 (UTC)

The scientific question has already been addressed. Check the above :

1. Does Chromium (or endogenous GTF)facilitate insulin action?

Even the study provided by JfWollff confirms this : Biochemistry 1996 Oct 1;35(39):12963-9. "A biologically active form of chromium may activate a membrane phosphotyrosine phosphatase (PTP)." It states that "a biologically active form of chromium in mammals (GTF), potentiates the effect of insulin on the conversion of glucose into lipid and into carbon dioxide in isolated adipocytes."

2. Does this Chromium / GTF effect take place inside or outseide the cells ?

Even a knowledge of basic biochemistry would completely nullify the notion of GTF being intracellular, as it requires glutathione for function. Glutathione never enters the cells, nor could GTF due to its size and complexity. Therefore GTF or TAD complex must act outside the cells in the action of insulin rather than the activity of the cells themselves."

This has not been contradicted by any means. There is nothing left to answer. --JohnMurphy 21:25, 20 July 2006 (UTC)

This is starting to get circuitous. Nowhere does any article assert the relative importance of this GTF/insulin/chromium/PTP signalling vis a vis run-of-the-mill insulin/insulin receptor interaction. If you can suggest a resource that explains that succinctly, please do so. We may not be biochemists like you but we read medical research and have been to medical school. Going back to a "knowledge of basic biochemistry" is nonsense, because heavy Googling by me has not revealed a source suggesting that any of this is "basic biochemistry". Unfortunately I've recently dealt with a difficult user who continuously claimed his superiority as a result of the knowledge of biochemistry. I'm therefore being a bit more suspicious than usual when someone makes poorly supported claims in the name of "basic biochemistry".
Your comments about glutathione are extremely indirect and do not support your statements at all. JFW | T@lk 22:11, 20 July 2006 (UTC)
Your statement that glutathione is extracellular by definition is utterly wrong[3]. JFW | T@lk 22:18, 20 July 2006 (UTC)

1. The above study states that "a biologically active form of chromium in mammals, potentiates the effect of insulin". What else could "a biologically active form of chromium" be but GTF or TAD complex.

2. I did not suggest that GTF biochemistry is "basic biochemistry". It is basic biochemistry that glutathione and GTF do not enter the receptive cells. Glutathione facilitates cell transport. It is not subject to it. They would have no biochemical mean of getting there.

--JohnMurphy 22:54, 20 July 2006 (UTC)

--JohnMurphy 16:36, 21 July 2006 (UTC)==Chromium not working== Diabetes Care 29:521-525, 2006: Chromium not effective in an obese Western population. PMID 16505499. There's more evidence for valsartan! JFW | T@lk 21:32, 19 July 2006 (UTC)

Oh, simply google for "GTF insulin" and one understands why we're having this discussion. JFW | T@lk 22:11, 20 July 2006 (UTC)

1. "Googling" is not a means of carrying out thorough scientific research.

2. The degree of scientific validity does not depend on how many Google hits it gets.

3. Some science has been established with one study. Other facts are still in dispute after hundreds. There are also many cases of well accepted "human" biochemistry even being based on work only on vegetables such as the horseradish ! Most accepted human biochemistry was not even established using humans.

--JohnMurphy 23:12, 20 July 2006 (UTC)

And from these points follows what? How are they, especially the last two, connected with the issue being worked on here? And, please, JM, try to follow the ':' indent convention when replying to a comment. I've gotten lost a couple of times here. ww 23:14, 20 July 2006 (UTC)
They are merely responding to what is written above. However, relevant to the GTF question, it isimportant to evaluate scientific fact based on its consistency with the evidence : not how many Google hitsit gets, not who says it, not whether it is commonly believed, not whether or not it has been directly or conclusively proven (because few things in biochemistry ever are). All evidence concerning a Chromium structure (such as GTF) facilitating insulins stimulus of cells is consistent will all scientific evidence.
I've never used indents before. I copied what you did. It seems to work ! --JohnMurphy 23:31, 20 July 2006 (UTC)
Gald you like the indent thing. It makes discussion following rather easier, until there are so many it piles up on the right, at which point someone will giving up counting ':' and move it all back to the left.
Your comment on relevance is skew to WP's purpose. We are not here evaluating truth of some research result, we are reporting research results, and in so doing, necessarily attempting to evaluate credibility of the various results available, and all that. There are some pros here, who are fully capable of making such evaluations reliably, but they can get it wrong. Hence the discussion business (above and above). The expectation is that anything lots of editors think is not credible or sufficiently established or both will eventually be identified, and the article will benefit thereby.
In this case, as nearly as I can make out, the discussion is about an evidently still somewhat obscure point in re Cr and GTF. As such, perhaps the whole things doesn't belong here at all, since the is an article of first resort, and the Average Reader can be, and (speaking from painful experience here) will be lost in overmuch detail. Perhaps an article on the method of action of insulin? Or insulin itself? Anyway, something more technically oriented than this one. If the phrasing suggested is sufficient to confuse even the clinicians here, I think it's going to be confusing for the Average Reader, for whom we are writing. ww 16:12, 21 July 2006 (UTC)

1."We are not here evaluating truth of some research result, we are reporting research results". The validity of ALL research has to be evaluated. I've yet to see a piece of research that was beyond question and examination. Most research is insufficient and misleading.
2. The addition doesn't go in to "overmuch detail". It doesn't go in to any detail at all. It merely adds "secretion and action". To use only "formation" as it was, would be misleading, as it is scientifically incorrect.
3."If the phrasing suggested is sufficient to confuse even the clinicians here". It did not confuse them. They initially just did not know of it.
--JohnMurphy 16:36, 21 July 2006 (UTC)

One view in the very conventional medical is that Cr is involved in a not very well-defined way with Insulin and carbohydrate. The tool on that page for digging out peer-reviewed studies and papers may be useful to people who want to follow that up themselves. I've not yet met anything reliable presented to WP that has too many references for there to be a clearly written account of how it works. For the moment I'm included to stick with "not very well-defined". Midgley 14:49, 22 July 2006 (UTC)

I've got the 16th (most recent) edition of Harrison's Principles of Internal Medicine on my lap. I think that this is good indicator on how relevant this whole GTF/chromium thing actually is in this context.
On page 410 it reflects Midgley's statements (at Ganfyd) that chromium potentiates insulin action in IGT and may improve lipids. No mention of GTF. It is not mentioned in the diabetes section at all, and the only other mention is of Cr6+ in the toxicology section on page 2580. "Glucose tolerance factor" is not mentioned at all.
I must urge all editors to await consensus here before the putative phrase is reinserted. I'm somewhat weary of the activities of several editors who revert without any form of discussion here, such as Rok Bura and 88.106.
I'm happy to request formal community opinion on this topic, and have already asked members of two related WikiProjects for their views. I will leave a message on Rok Bura's page to reflect the above. JFW | T@lk 21:50, 23 July 2006 (UTC)

What is written above is based on the false asumption that one author in one book Harrison's Principles of Internal Medicine can determine all scientific fact. It is not even particular to this subject. True science makes use of all scientific fact - not just some general textbook. It does not address in any respect the sientific evidence and reasoning provided. --JohnMurphy 12:25, 24 July 2006 (UTC)

That's not what I suggested. Scientific fact is only half the answer here. We're talking about relevance. If serial trials suggested that every diabetic should take chromium supplements, then there would be a lot more to talk about. See Alteripse's view below. JFW | T@lk 14:10, 24 July 2006 (UTC)

reversion of para removal[edit]

Stonbull, Your edit comment is either wrong or confusing. The amount and trendline of DM is certainly significant. And that it is in the top ten or higher is certainly a useful fact. Or you meant something else altogether. Thoughts? ww 16:12, 21 July 2006 (UTC)

removal of synthesis from intro paragraph[edit]

There are many causes of inadequate secretion just as there are many causes of inadequate responsiveness. Specific defects of insulin synthesis (e.g. mutations of the insulin gene) are very rare causes of inadequate secretion compared to common causes of inadequate secretion like destruction of beta cells or defects of intracellular signalling. We can mention synthesis defects as part of a more detailed listing of possible causes of impaired secretion. alteripse 03:54, 24 July 2006 (UTC)

Alteripse, I was hoping to keep the intro a bit shorter. When I redid the intro recently I made it as tight as I possibly could, including not spending too much times on the details of each type of diabetes, which are covered in extenso later on in the article.
Let's reduce the size of the descriptions then. We should give a sense that the concept of 3 forms is becoming less useful and more criticized because additional forms are being discovered, because each type is clearly heterogeneous and represents a pattern of development rather than a single etiologic entity, and because a rising percentage of patients are recognized to have combinations of features of more than one type. alteripse 11:17, 24 July 2006 (UTC)
Given that you're an endocrinologist, could you comment on the discussion me and ww have been having with JohnMurphy about the relative role of chromium and GTF? JFW | T@lk 07:20, 24 July 2006 (UTC)
Cr (and GTF) is one of a thousand minor aspects of glucose physiology that had its 15 min of interest several years ago as a possible major factor in type 2 pathophysiology. It has not turned out to be very important very often. In any 6 month period I can offer (or you can find) another dozen aspects of metabolism that looked intriguing but turned out to be of limited relevance because it was clearly secondary to other changes, or it accounted for only a small fraction of the impairment of secretion or action, or it was found only for a small fraction of patients. GTF faded long ago as an important factor in human type 2 pathophysiology. It might be mentioned with a hundred other minor aspects of metabolism in a section on the pathophysiology of type 2 but is not important enough to be included in this overview article. I was recently updating my teaching materials related to type 2 and combed the literature of the last couple of years on type 2 and the various treatments. Not a single review or overview of type 2 pathophysiology or treatment published in the last 2 years thought it even worth mentioning; I went to the ADA scientific meetings last month where there were literally thousands of reports and overviews of current research; I do not remember even a mention of Cr or GTF. I will take a look at Murphy's arguments above but basically GTF is not one of the hundred basic facts about diabetes that belongs in an overview article. alteripse 11:17, 24 July 2006 (UTC)

The above does nopt address in any resepcet the only scientific questions of significance, repetaed below :

1. Does Chromium (or endogenous GTF)facilitate insulin action?

Even the study provided by JfWollff confirms this : Biochemistry 1996 Oct 1;35(39):12963-9. "A biologically active form of chromium may activate a membrane phosphotyrosine phosphatase (PTP)." It states that "a biologically active form of chromium in mammals (GTF), potentiates the effect of insulin on the conversion of glucose into lipid and into carbon dioxide in isolated adipocytes."

2. Does this Chromium / GTF effect take place inside or outseide the cells ?

Even a knowledge of basic biochemistry would completely nullify the notion of GTF being intracellular, as it requires glutathione for function. Glutathione never enters the cells, nor could GTF due to its size and complexity. Therefore GTF or TAD complex must act outside the cells in the action of insulin rather than the activity of the cells themselves."

This has not been contradicted by any means. There is nothing left to answer.

All that Alteripse has written is how much attention it receives. Scientific fact is not determined by how much attention something gets. he has completely failed to contradict the scientific facts detailed above, and therefore has no scientific basic for his views.--JohnMurphy 12:31, 24 July 2006 (UTC)

As Alteripse has stated, the significance of chromium is so minor that we should not make the intro more confusing at the expense of putting in every little detail. Please stop reinserting the same words until you have achieved consensus here on the talk page. At the moment most editors oppose giving specific mention to "insulin action" to cover the possibility of a role for chromium/GTF. Would you like a full request for comments? JFW | T@lk 14:10, 24 July 2006 (UTC)
Alterpiece has merely stated that the significance of chromium is minor. He has provided no scientific evidence at all. So it is merely unsubstantiated opinion. Nobody has been able to provide any opposing scientific evidence. The wording of the article should reflect the current state of the discussion which is that there is substantiated sientific evidence and reasoning in favour, but no scientific evidence against. --JohnMurphy 14:41, 24 July 2006 (UTC)
Proving a negative can be difficult. Whether or not chromium has an important role is still debatable, but it seems that any role it does play seems minor, and an overview article should reflect that and not give to much attention to a minor detail. Of note, an article in Diabetes Care from March 2006 did not find any clinical benefit to chromium supplementation PMID 16505499. (cmnt added by 11:37, 24 July 2006 Andrew73), pls use 4 twiddles ('~') in a row in future to sign your posts).

OK, JohnMurphy, if you insist I will specifically and explicitly contradict your claims and arguments.

  1. Cr in some laboratory models in vitro and in vivo can facilitate insulin action. To date there have been no published studies demonstrating that this is clinically usable information or even very important physiologically. It is absolutely and definitely not one of the hundred most important facts about diabetes.
  2. Does the effect occur inside or outside the cells? It really doesnt matter since it has never been shown to be a very important in vivo effect in human beings on ordinary diets and doesnt belong in this article either way. Your claims about glutathione should embarrass you and certainly tells us you are not a biochemist engaged in carbohydrate metabolism research.
  3. Scientific fact does not indeed depend solely on how much is published, and I can quickly cite you a couple of recent studies that may turn out to be important but do not yet have lots of papers about them. However, when a phenomenon has been known for twenty years, has been looked at by dozens of researchers and more than one biotech company, and nothing has been made of it after all that time, it is reasonable to conclude it is not yet very important.
  4. While it doesnt necessarily determine what is scientifically factual, the amount of research is one of several useful indicators of what is important enough for an encyclopedia article.
  5. Your argument that something unsupported by evidence should be mentioned because it has not been disproven is simply idiotic. Is that enough contradiction for you? alteripse 20:29, 24 July 2006 (UTC)
Given that JohnMurphy has now reinserted the same disputed words several times I think it's good we ask for community opinion. I have made an entry[4] and hope we can sort this out. JFW | T@lk 22:48, 24 July 2006 (UTC)

Summary for RFC[edit]

On 18 July editor Xemxija changed the intro to include that diabetes may be caused by a problem in the action of insulin. I removed this, given that the main problems in diabetes are due to impaired pancreatic secretion or tissue insensitivity to insulin. In my view, problems with the action of insulin are not really of relevance in diabetes. Xemxija reverted, suggesting that GTF (glucose tolerance factor) plays a role in insulin action, and that problems with GTF hence cause diabetes. Extensive searching by myself failed to confirm good evidence of such a link, although alternative health sites abound that suggest that GTF or chromium improve diabetes.

Rok Bura reverted several times on 19/7, but has not discussed the issue here (nor has Xemxija, who has disappeared), but JohnMurphy was willing to discuss the topic. Still, many other editors (myself, Alteripse, David Ruben, AndreasJS, WW) are of the view that while there may be some scientific support for a role for GTF/chromium, this is presently much too tentative to adapt the lead section of this article to include this view.

John has now reinserted his version ([diabetes] result[s] either from inadequate biosynthesis, secretion or action of the hormone insulin [...]) several times despite the responses here. I have provided several arguments, including the complete absence of the whole topic in a very well known clinical handbook known for its comprehensiveness, and was wondering if there were other views on this matter. JFW | T@lk 22:48, 24 July 2006 (UTC)

"Characterised by" rather than "results from", otherwise we risk chasing a regression back to the first egg. Midgley 23:10, 24 July 2006 (UTC)
... the silence is deafening. JFW | T@lk 10:38, 26 July 2006 (UTC)

I am still not certain what the issues are. I gather the following separate items are worth addressing:

  1. The intro paragraph should say something equivalent to "diabetes is persistent hyperglycemia caused by defects of insulin secretion and/or action", or "defects of insulin secretion or tissue responsiveness." We should avoid listing one or more subsets of those, especially the minor ones, such as defects of biosynthesis. There are several known defects of biosynthesis (e.g., mutation of the insulin gene), but collectively they are a small subset of defects of secretion.
  2. Cr and GTF is a relatively trivial topic that warrants about one accurate sentence in the article on type 2.
  3. Points 1 and 2 are not my "opinion" or jfw's opinion or ww's opinion, but the views expressed in every current textbook or authoritative medical journal review article about diabetes. Not a single citation has been offered to contradict this. An encyclopedia expresses the knowledge of currently accepted authoritative sources, which are unanimous on these issues. Editors who cannot understand or accept this need to be encouraged to move on. alteripse 12:16, 26 July 2006 (UTC)

Temperature Extremes and Hypoglycaemia[edit]

Many thanks for the comments that some one (I believe a Wikipedian medical expert) made when I raised on the article on hypoglycaemia the question of whether temperature extremes, either extreme cold or extreme heat, can increase risk of hypoglycaemia in diabetics. The response I had was that it might be more appropriate to raise this discussion here rather than there, so I shall ask now:

Does extreme heat or extreme cold increase risk of hypoglycaemia in diabetics? Please note that, as in the United Kingdom we are currently having the hottest July on record, this is a very important issue to discuss. I wish to point out that I suffer from Type One diabetes mellitus myself, and a friend of mine remembers an incident several years ago (I think it was 2003) when I seemed to come over faint on a hot day, as if my blood sugar had dropped low. ACEO 12:39, 26 July 2006 (UTC)

ACEO, I guess I have to offer the usual warning that WP is not a suitable source of medical advice. And, that out of the way, suggest that one of the editor docs is probably a better source of an answer (if one there be) here. But ...
Temperature extreme is a kind of stress on body organs and, like all stress, provokes assorted reactions, quite normally. Among these can be one or more of the 'stress hormones' and several of these have effects on metabolic regulation (or one of the numerous other systems insulin controls or influences). So, yup might do.
On the other hand, diabetics (most especially long term ones) have accumulated a good bit of tissue damage (vessels large and small, kidneys, perhaps retinas, nerves, ...). And quite a few type 1s (especially) have 1ost part of the homeostasis surrounding the insulin/glucose system (eg, glucagon secretion response) and so diabetics will have additional problems which may turn up in this context. As an American, my Leader has spoken (ie, explaining that this global warming stuff just isn't good science) so my suggestion to move to a cooler climate is obviously correct. Greenland will be glad to have you, I suspect. Though if my Leader's tree-hugging oppostion is correct, there may be some problem with that.
Get an air conditioner, and add this to the list of things you must consciously consider that non-diabetics can by and large blithely ignore. ww 14:06, 26 July 2006 (UTC)

See answer at talk:Diabetic hypoglycemia. alteripse 19:26, 26 July 2006 (UTC)