Tag Archives: type 2 diabetes

Obesity Related Type 2 Diabetes is More Severe in Teens than Adults


Overweight TeenObesity Related Type 2 Diabetes is More Severe in Teens than Adults

by Gary Pepper, M.D. and Andrew Levine, Pre-Med, Univ of Central Florida

The recently published TODAY study found obesity related type-2 diabetes mellitus (T2DM) is more severe as a teen than as an adult, and high risk of developing diabetes could be tied to weight gain at an early age.

Between 2004 and 2009 the “Treatment Options for Type 2 Diabetes in Youth Study Group” (TODAY) gathered 700 participants who met the American Diabetes Association’s criteria for this disease.  The participants were monitored for between two to six years.  TODAY’s goal was to assess treatment options and the clinical progression of obesity related T2DM in youth.  The mean age of the 700 participants in the TODAY study was thirteen, the majority being female. Sixty percent of the 700 participants were African American or Hispanic, with the remainder being Caucasian. The mean duration of diabetes for the study’s’ participants was less than seven months. A major worrisome finding from the study is a majority of participants were also discovered to have dyslipidemia, an abnormally high amount of fats (cholesterol, triglycerides) in the blood, as well as high blood pressure (hypertension). Continue reading

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What Product Contains 5 Times a Child’s Daily Sugar Allowance?


sugar babies Poor eating habits are contributing to the rise of type 2 diabetes and obesity in children and adolescents.  One of the major nutritional culprits is the high consumption of sugar contained in soda.  The amount of sugar in soda is astounding.

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What is Behind the Epidemic of Obesity and Type 2 Diabetes in Children and Teens in the U.S.?


by Gary Pepper, M.D. and Andrew Levine, Pre-med

If you ask the average person to define diabetes, a typical response might be “it’s when you have unhealthy eating habits and an overabundance of sugar in your blood.”  Although that is not far from the truth, a more accurate definition is that diabetes is a disorder in the way our body uses insulin to process digested food for energy and storage. A good part of what we eat is broken down into glucose, the principle form of sugar in the blood. Diabetes occurs when there is not enough insulin to push the glucose into our cells. This deprives the body of the energy it needs because glucose is metabolized as fuel by all the organs in the body. Therefore in diabetes despite an elevated amount of sugar in the blood,  the cells are actually starving for energy.  We sometimes conceive of glucose in the blood as the enemy , but without it we would die. Continue reading

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Polycystic Ovarian Syndrome Is Common in Adolescent Girls


Polycystic Ovarian Syndrome (PCOS) sounds like a rare disorder but it is surprisingly common. This is a disorder with onset in early adolescence effecting up to 10% of young women. Characteristic signs and symptoms include increasing facial and body hair, hair loss from the scalp, muscular or heavy build, acne, thickening and darkening of the skin known as acanthosis nigricans, blood sugar problems including type 2 diabetes, high cholesterol and irregular menstrual cycles and infertility. In older women with PCOS coronary artery disease is more common. In severe cases deepening of the voice and enlargement of the clitoris (clitoromegaly) can be seen. Before the underlying hormone disorders were clarified, the main method of diagnosing this disorder was by finding multiple cysts on the ovary. We now understand that the main problem is not the ovarian cysts but metabolic disorders including insulin resistance and elevated male hormone levels (testosterone) in the blood.

Another misconception about PCOS is that it only occurs in overweight women. Obesity is common in PCOS but thin women are also capable of developing PCOS. The underlying hormone problems are complex but are thought to be at least in part due to high insulin levels in the blood resulting from insulin resistance. With insulin resistance the body requires high levels of insulin due to insensitivity of the tissues to insulin’s presence.
What treatments are available for PCOS? There are very few, if any, drugs specifically approved for the treatment of PCOS. This is probably because of the low profit potential for treating this disorder. Drug companies cannot afford to invest millions of dollars in research because almost all of the existing standard therapies are generic drugs. Some of the most useful medications for treating PCOS are drugs used to treat type 2 diabetes because of their effect to reduce insulin resistance. These drugs are metformin and Actos. Metformin is the most popular oral medication for diabetes treatment in the U.S. Actos has been available for about 10 years but due to recent negative publicity about an unproven risk of bladder cancer, its popularity is declining. Neither drug is approved by the FDA for treatment of PCOS but multiple studies confirm the clinical and hormonal benefits of using these medications in this disorder. In 2011 research was published in the Journal of Clinical Endocrinology and Metabolism suggesting that the generic cholesterol lowering drug, simvastatin may also show benefits similar to metformin for the treatment of PCOS.

In the late 1980’s, I along with Dr. Lester Gabrilove at Mt. Sinai Hospital in New York, published our research showing that an anti-fungal medication, ketoconazole, could reverse the hormonal, physical and metabolic problems associated with PCOS. Due to the potential toxicity of ketoconazole this therapy never gained wide spread acceptance. The manufacturer refused to fund additional studies to determine how to more effectively use this drug, due to the low profit potential and liability concerns.

This information is strictly for educational puroses. Due to high risk of toxicity of medical therapy in young women who can potentially become fertile under treatment for PCOS, no drug should be taken without the close supervision of a physician. The reader agrees to the Terms of Service of this website, metabolism.com

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Diabetes Medications, One Old and One New, Run into Trouble


A potential new treatment for type 2 diabetes, dapagliflozin, recently failed to gain approval from the FDA. What makes this rejection noteworthy is that the new medication works by a completely new mechanism causing the kidney to excrete sugar from the blood into the urine. Reasons for the rejection were the increased risk of bladde and breast cancer in those taking the medication, increased urine and genital infections and possible liver toxicity. That list of problems seems pretty convincing to me. This is unfortunate because the drug appears to cause weight loss and does not cause low blood sugar (hypoglycemia). However, a drug that works by “poisoning” the kidney so that it dumps sugar into the urine strikes me as a drug that is going to cause a lot of other problems.

The other established diabetes medication generating new warnings is Actos (pioglitazone). I have written a number of articles on the sister drug Avandia, defending its usefulness despite possible cardiovascular risks, but the cancer warning for Actos is a new angle on this class of drugs (thiazolidinediones). Actos has been withdrawn in France due to concerns that it may cause bladder cancer but no such action has been taken in the U.S. The FDA this month did issue a warning that individuals with bladder cancer or at risk for bladder cancer, should be advised not to use Actos. If Actos is hit hard by these actions this whole class of diabetes drugs will have been eliminated from use.
A sure sign of trouble for Actos is that a “google search” for Actos is now showing lawyer websites as the first 5 citations.

Being sick is dangerous. Treating illness also has dangers. I am concerned that our cultural zeal for uncovering scandals and for pursuing litigation will lead us to sterile treatment options and doctors who are unwilling to risk helping.

Gary Pepper, M.D.
Editor in Chief, metabolism.com

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Newly Diagnosed with Low Testosterone John Wonders About His Treatment


John has recently been diagnosed with low testosterone levels and sends metabolism.com this inquiry:

John writes;

I’m so glad I found this site! About a month ago I was diagnosed with low T – mine is 140. Very, very low. Symptoms were NO libido, fatigue, massive weight gain (from 195 to 275 in 9 months), swelling below the knees. Not sure if the T is responsible for all of this, but would love your opinion (at the same time – the same day, actually – i was also told I had type 2 diabetes (blood sugar of 203). Is there a link here?

My endocrinologist put me on Enenthate shots, 1ml every 2 weeks (done 2 shots so far). Do you think this is a good dosage? Are the shots better than the cream? I’m concerned about see-sawing T levels – will they go up after the shot but creep back down again before the next treatment?

I’d really appreciate any insight, my doc did not spend a lot of time going into these kinds of details with me, it was a bit disappointing. I’m a white male, a little over 6′ and 42 years old. Naturally I understand you are only giving an opinion, not actual medical advice. Thanks so much.

Reply by Dr. Pepper:

Thanks for your inquiry John. My first thought about the situation you describe is why would a 42 year old man develop low testosterone? Personally, I never take it for granted that the cause of newly diagnosed low testosterone is “aging”. There are many significant medical conditions that need to be ruled out primarily disorders of the testicle, and pituitary gland. Additional blood tests such as LH, FSH and prolactin and possibly radiological tests are often needed to make that determination. I don’t want to go on a wild goose chase here but swelling of the legs, rapid weight gain, low testosterone and type 2 diabetes may all be caused by an excess of cortisol in the body, known as Cushing’s Syndrome. That could be one way to unify all the events you describe.

Testosterone is generally administered as an injection or rubbed on as a gel. In nature, testosterone levels are more or less constant from day to day, so applying testosterone gel every day mimics this environment pretty well. The injections given every two or three weeks cause a rapid increase of testosterone to unnaturally high levels followed by steady decline often to low levels again before the next shot. My opinion is that shots are much less desirable although they tend to be a lot cheaper and simpler than the daily gels.

You may want to seek a second opinion to find out if other problems exist to explain how you developed low testosterone in the first place.

Keep us posted and good luck.

These comments are for educational purposes only and are not intended to provide medical care or advise.

Gary Pepper, M.D., Editor in Chief, Metabolism.com

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Can Actos Really Prevent Type 2 Diabetes?


Diagnosing diabetes is simple. If the blood sugar is found to be elevated you are diabetic. Increasing or decreasing the cut off level between normal and diabetic will dramatically change the number of people diagnosed with diabetes. In 1997 the American Diabetes Association lowered the criterion of diabetes (type 2) to a fasting blood sugar above 126 mg/dl instead of 140 mg/dl. Suddenly 1.7 million Americans became “diabetic” under the new definition.

In the latest issue (March 24, 2011) of the New England Journal of Medicine research was published stating that Actos (pioglitazone), a popular medication used to treat type 2 diabetes, could substantially reduce the percentage of people at high risk for developing diabetes who progress to actual diabetes. 600 people with a form of pre-diabetes known as impaired fasting blood sugar (fasting blood sugar levels between 95 and 125), were divided into one group given placebo and the other group given Actos. After 2.5 years Actos reduced the incidence of developing type 2 diabetes by 72% compared to placebo. Initially, I was very impressed with these results.

Actos is the sister drug to Avandia and Rezulin. All of these drugs show similar ability to reduce blood sugar in diabetics. Rezulin and Avandia fell into disfavor due to the potential for side effects. Actos is considered safer.

It seems almost a little too obvious that if diabetes is defined as elevated blood sugar that if the test medication reduces blood sugar, diabetes can be “prevented”. Since Actos lowers blood sugar, the conclusion that Actos reduces the progression of pre-diabetes to actual diabetes seems inevitable. A substance that does not already lower blood sugar which prevented elevated blood sugar from developing would be far more impressive.

Side-effects of taking Actos need to be considered, as well. In this research study (New England J of Medicine 364; 12, 2011) the group taking Actos gained an average of about 9 pounds. That doesn’t include the 3% of test subjects who dropped out of the study because they gained too much weight. Edema (puffy ankles) was also more common in those taking Actos. We know that weight gain, particularly in pre-diabetics, is not a good thing. What are we hoping to accomplish by using Actos to prevent diabetes when at the same time, we make people chunkier and puffier?

To be fair, the family of medications known as “glitazones” which contain Actos, Avandia and Rezulin, have some intriguing properties. Years ago, the Triad Study, showed that women with gestational diabetes who received Rezulin, did not go on to develop type 2 diabetes nearly as often, even years after stopping this medication. This does seem like a true preventive benefit.

I am dubious about using Actos to prevent diabetes at this time. My patients, I suspect, will agree with that decision. I don’t think I would survive very long in practice, if my patients gain 10 or more pounds as I try to “prevent” their progression to diabetes.

This information is for educational purposes only and is not intended as medical advise or treatment. Always consult with your physician when deciding whether to use a prescription drug.

Gary Pepper, M.D.

Editor-in-Chief, Metabolism.com

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Dangerous Weight Loss Programs for Diabetics


A few days ago I was concluding a visit with a patient with thyroid disease, while her diabetic
husband, also my patient, looked on. They are a pleasant older couple I have known for
years, who are devotedly helping each other stay healthy. As they were leaving the exam room the
wife apologetically turned the subject to her husband mentioning he was having almost
daily “episodes” of weakness and confusion. “I hadn’t changed his diabetic medication recently
so why should his blood sugar be an problem now”, I thought. A number of other unpleasant
possibilities immediately occurred to me. I inquired about signs of a possible stroke or heart
condition. If these other angles were unproductive I faced the choice of sending him to the
hospital for an evaluation. We quickly ran through a routine systems review. He had lost 10
lbs in the past month, the wife mentioned. “Oh, no, cancer” , was my first thought. His wife
explained that as a New Year’s resolution he enrolled in a commercial weight loss program for
diabetics. With relief, I knew we had the explanation of his disturbing new symptoms.

Most of my diabetic patients are on medication since they are unable to maintain good glucose
control with diet and exercise only. If they succeed however, in achieving weight loss then the
diabetes medication must be reduced to prevent undesirable hypoglycemia (low blood sugar).
Hypoglycemia is potentially dangerous because the brain cannot function properly resulting in
abnormal behavior, loss of muscle control and even unconsciousness. Imagine this occurring
while behind the wheel? Down here in Florida this is all too common.

Many commercial weight loss programs have started targeting Type 2 diabetics (adult onset)
with their TV ads. These programs are generally administered by people without any medical
background. They cannot advise medication changes (not that you would want them to) without
breaking the law by practicing medicine without a license. The result, as with my patient, is the
development of potentially serious complications of hypoglycemia.

In a previous blog http://www.metabolism.com/2010/10/17/injured-diabetic-diet , I worried that this type of problem could develop with commercial weight loss programs. I didn’t expect to see evidence of it so soon and in my own exam room. If my patient’s wife didn’t stop and mention his new symptoms at the last moment
that day, I imagine a far worse outcome for her husband was possible.

Gary Pepper, M.D.
Editor-in-Chief, metabolism.com

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Low Vitamin D Linked to Obesity and Atherosclerosis in Diabetics


Type 2 diabetics are more prone to heart attacks, peripheral vascular disease and stroke. All of these can be linked to hardening of the arteries (atherosclerosis). Known risk factors for atherosclerosis are high cholesterol levels, obesity and high blood pressure. A recent study now demonstrates that atherosclerosis and obesity are associated with low vitamin D 25 levels in African-American type 2 diabetics. This study published in the March issue of JCEM was conducted at Wake Forest University School of Medicine. The researchers found that low vitamin D levels in diabetics are more common with increasing obesity and also with greater degrees of atherosclerosis of the aorta and carotid arteries (which supply the brain with blood).

Whether low levels of vitamin D cause any of these diseases or are simply another abnormality found in people with these illnesses has yet to be determined. Future studies are being planned in which obese type 2 diabetics are treated with vitamin D to see if these diseases can be improved.

Gary Pepper, M.D. Editor-in-Chief, Metabolism.com

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Al, Type 2 Diabetic, Shares His Thoughts on Treatment


Al is a type 2 diabetic. He has learned a lot about how diet and exercise can influence his blood sugar but still has frustrations with treatment options. He shares his thoughts with metabolism.com:

I am a male 47 years of age. 2 years ago my A1C was at 9.9 i was eating horribly and not exercising. Now my diet consists of South beach diet phase 2 my A1C is now 6.5 and my sugars are between 80 to 130 . My exercise routine is every other day due to my weight I am 5′ 7 1/2 lbs and at 282lbs my back is killing me.

I understand that there needs to be a lot of testing for these things and rightly so. Ive noticed that there is some hazards with Byetta and am glad im not on that and on avandia. I must point out that with the problems diabetics already have we do not need to compound it with more even though I do wish the testings would some how be able to go faster and that more and more research is done with stem cell testing.

My next option is to go for bariatric surgery..but my insurance wont cover it.

So here i am at a catch 22 . I hope they come up with something soon.

I am a male 47 years of age. 2 years ago my A1C was at 9.9 i was eating horribly and not exercising. Now my diet consists of South beach diet phase 2 my A1C is now 6.5 and my sugars are between 80 to 130 . My exercise routine is every other day due to my weight I am 5′ 7 1/2 lbs and at 282lbs my back is killing me.

I understand that there needs to be a lot of testing for these things and rightly so. Ive noticed that there is some hazards with Byetta and am glad im not on that and on avandia. I must point out that with the problems diabetics already have we do not need to compound it with more even though I do wish the testings would some how be able to go faster and that more and more research is done with stem cell testing.

My next option is to go for bariatric surgery..but my insurance wont cover it.

So here i am at a catch 22 . I hope they come up with something soon.

Al Lazzara

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