Tag Archives: 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 Associations criteria for this disease.  The participants were monitored for between two to six years.  TODAYs 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 studys 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

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


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.

According to The American Heart Association, sugar intake should be limited to six teaspoons per day for women (equivalent to about 100 calories),   nine teaspoons per day for men (about 150 calories)  and three teaspoons for children (about 60 calories) . There are numerous drinks available on the market  containing as much as 14.6 teaspoons, or 73 grams, of sugar in a 20 oz bottle.  A single 20 oz bottle therefore has almost 5 times the recommended daily sugar allowance for a child,  2-1/2 times the recommended allowance for women and 1-1/2 times the recommended allowance of sugar for men.

Continue reading

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

New Prescription Weight Loss Drug, QSymia, Available


About two years ago I wrote a blog about the latest two weight loss drugs to be rejected by the FDA. One of these drugs was Qnexa a combination pill made up of two well established medications, phentermine and topiramate (Topamax). At that time the FDA felt there was not

Continue reading

Low Vitamin D Linked to Obesity and High Triglycerides


Understanding of the various ways vitamin D effects the body is growing rapidly. Originally this vitamin was thought to only effect calcium in the blood and bone but recent research shows it possesses important influences on the immune system and cancer development. A study just published in Journal of Endocrinology and Metabolism June 2012 now shows that this same vitamin can possibly influence metabolism. A common disorder of metabolism known as Syndrome X or the Metabolic Syndrome is characterized by high triglycerides and low good cholesterol (HDL), abdominal obesity, along with elevated blood pressure and blood sugar. The researchers discovered those with vitamin D levels between 16 and 20 were 75% more likely to develop the Metabolic Syndrome within 5 years than those with vitamin D levels above 34 (levels below 30 are considered low).

Whether low vitamin D is the cause of the Metabolic Syndrome is unclear. Vitamin D prevents fat cells from reproducing, helps the natural process of triglyceride breakdown and helps regulate blood sugar by making insulin work more efficiently. Without enough vitamin D the fat cells could multiply faster, triglyceride levels accumulate and blood sugar rise as is seen in Metabolic Syndrome.

As I have explained in previous posts at metabolism.com, vitamin D is also related to development of hardening of the arteries (atherosclerosis) and obesity in Type 2 Diabetes which could be considered a more advanced form of Metabolic Syndrome.

Doctors’ efforts to monitor vitamin D levels are being hindered by new regulations by Medicare and private insurance carriers to deny payment for vitamin D screening. Lately, a number of my patients’ vitamin D tests were denied by insurance carriers with patients being charged over $200 per test because it was not “indicated”.

Recommendations for vitamin D supplementation are debated. When skin is exposed to sunlight it manufactures vitamin D so there is thought that people who get sun exposure should not need vitamin D supplement but that is not borne out in reality. Previously the recommended daily allowance (RDA) was 400 units per day an amount which has been increased slightly for the elderly. Some experts recommend 1000 unit daily or more. In my practice I generally recommend starting at 1000 units and then rechecking 25 hydroxy vitamin D levels a few months later. Some individuals require 4000 unit or more daily to achieve vitamin D levels over 30. When purchasing vitamin D the D3 form appears to be converted in the body more rapidly than the D2 variety. High priced brands of vitamin D, in my opinion, are a waste of money.

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

Infertility to Acne: Treatment and Prevention of Polycystic Ovarian Syndrome. Part 2


Worried about pregnancyIn part one of this series we looked at the cause of polycystic ovarian syndrome (PCOS) and the many complications it causes. Weight gain, acne, excess hair growth on the face and body,  high cholesterol and high blood sugar due to insulin resistance are among the problems associated with PCOS.  One particular area of concern for PCOS sufferers is infertility due to lack of ovulation. PCOS is the cause of anovulatory infertility in  3 out of 4 cases. Before the acceptance of medical therapy for infertility due to PCOS  a surgical approach referred to as a wedge resection of the ovary was performed which allowed patients with PCOS to ovulate and conceive normally. Low success rates with this procedure, complications of surgery and improved medical therapies have all resulted in the end of this type of treatment in most situations.  At present, treatment of infertility associated with PCOS generally consists of using a drug to combat insulin resistance known as metformin often in combination with the fertility drug clomid, which has a high rate of success.

Treatment of the excess hair growth associated with PCOS often consists of using the drug spironalactone and the use of birth control pills. Spironalactone is a very interesting drug used for decades as a salt depleting diuretic but also has an effect to block the action of the male hormone testosterone. The action of spironalactone to block testosterone was discovered when it was noticed that men using this diuretic developed tender nipples and breast enlargement (gynecomastia). Oral contraceptive agents are also useful to combat hirsutism because these agents also cause reduce testosterone levels by putting the ovary in a dormant “resting” state.  Cosmetic procedures are always another option to treat unwanted hair growth. Laser hair removal appears to be replacing the older modality of electrolysis for this purpose.

Can PCOS be cured? Once PCOS develops it can be controlled but not cured unless the ovaries are removed. At menopause  PCOS-related problems diminish as the ovary stops making sex hormones including testosterone which is one of the culprits during the reproductive years. A recent study published this year in the journal Pediatric Endocrinology showed that using metformin treatment in pre-adolescent girls thought to be at risk for PCOS reduces the risk and/or the severity of PCOS in later years. It may do this by blocking fat accumulation in the abdomen and liver which seems to set off the insulin resistance. Metformin is not FDA approved for this purpose and as a generic drug there is little profit potential in developing this treatment. I expect it will be many years before preventive therapy for PCOS will come before the FDA for approval .

This information is strictly for educational purposes. 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