I was diagnosed with pernicious anemia in 1982 and prescribed 1000-microgram shots of B12 (cyanocobalamin) every month for the rest of my life. I have since moved, and my current doctor advises that 100 micrograms a month is sufficient, a dose I have been taking for more than two years. I have many health problems and am wondering if a lack of B12 could be causing them.

Billie

There is study data to support both doses. To confirm the best amount for you, we suggest that you consider asking your doctor to order a complete blood count (CBC) to examine the number, size, and shape of your blood cells.

The term “pernicious” or “fatal” anemia dates back to the time before scientists discovered that it is a vitamin deficiency disorder. Characteristic signs and symptoms of the condition include feeling tired and weak, tingling and numbness in hands and feet, and a bright red, smooth tongue. Your cardiovascular health problems seem to have started before switching to the lower dose of cyanocobalamin.

Treating Pernicious Anemia The Saturday Evening Post

Ablation procedures are usually catheter approaches designed to eliminate tissue in the heart responsible for causing, or contributing to, an arrhythmia—in your case, atrial fibrillation. This is commonly achieved with radio-frequency-produced burns and sometimes by freezing, delivered over the catheter tip. At times the first ablation procedure doesn’t destroy all the necessary tissue, and the arrhythmia recurs. Other times, the tissue appears dead during the first procedure but recovers over time to cause the arrhythmia again.

Whichever, a second ablation attempt is often successful. We perform such procedures in octogenarian patients, but it depends on how “young” the 80-year-old is. Your own doctor is in the best position to make that judgment call. Without question it would be nice for you to be able to stop your medications. That is why ablation procedures have become so popular. In fact, electrophysiologists are among the very few physicians in cardiovascular medicine who can produce an actual cure of a problem. However, there are some risks, particularly in the elderly and with second procedures, which is why your doctor is being cautious. I would suggest you and your doctor discuss the pros and cons and come to a decision with which you are both happy.

Second Ablations Often Succeed The Saturday Evening Post

Solving the Diabetes Puzzle

An international scientific consortium reports that at least six previously undetected genetic variants are involved in type 2 diabetes, boosting to 16 the total number of genetic risk factors associated with increased risk of the disease. The surprising discovery provides clues about what goes awry when diabetes develops, and may someday lead to new ways to treat or even prevent it. In the future, genetic testing may help doctors and their diabetic patients develop individualized treatment and lifestyle plans. Former director of the National Human Genome Research Institute Francis S. Collins, M.D., Ph.D., is a coauthor of the study conducted by the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) group.

Work by an Australian Ph.D. student revealing a new action of insulin may explain how it prompts body cells to absorb glucose, a question that has perplexed scientists since the 1920s discovery of the drug. Freddy Yip’s groundbreaking finding suggests that diabetes may develop when signals between insulin and the myo1c protein become blocked. Learning more about this mechanism may yield innovative therapies.

Not Diabetic? Two Reasons to Get Tested

People with high blood pressure should be screened for diabetes, even though they show no signs of it, according to recently updated federal guidelines. The U.S. Preventive Services Task Force confirmed that screening is “moderately certain” to be of substantial benefit for adults with a sustained blood pressure greater than 135/80. In a major change, the group dropped a general recommendation that adults with high blood levels of fats (hyperlipidemia) get screened for diabetes, citing a lack of evidence as to whether this is beneficial. Testing might still be warranted for those with additional cardiovascular risk factors, such as a family history of diabetes, they added. Another group who should watch their blood sugar levels are those undergoing heart surgery. In a Michigan study, nearly half of all heart surgery patients experienced blood sugar levels high enough to require temporary insulin treatment after their operation, despite never having diabetes.

Avoiding the “Ouch”

Here’s a new spin on the old adage that necessity is the mother of invention. When one Texas mother tired of the multiple insulin injections needed to treat her diabetes, she invented a simple and convenient alternative to the standard shots. The disposable i-port injection port, about the size of a quarter, minimizes the need to puncture the skin with each dose of medicine. When applying the adhesive device, an insertion needle guides a tiny, flexible tube under the skin. The insertion needle is then removed and the soft tube remains below the skin, allowing access into the underlying tissue. Up to 75 insulin doses from a syringe or insulin pen may be delivered through the i-port without puncturing the skin. Patton Medical Devices, the manufacturer of the device, is planning clinical trials to further support the medical need for the prescription-only device and to explore additional uses. For more information, visit i-port.com.

Drug Developments

An experimental insulin nasal spray may someday offer diabetics a fast and convenient option for mealtime glucose control. Phase II clinical testing shows that the ultra-rapid-acting intranasal insulin maintained safe glucose levels better than oral antidiabetes medicines and basal insulin. In addition, the nasal spray performed as well as NovoLog, a rapid-acting injectable insulin. For the study, blood glucose was measured 60 and 90 minutes after a meal. Data were reported at the 2008 Scientific Sessions meeting of the American Diabetes Association.

Discoveries in Diabetes The Saturday Evening Post