Tag Archives: diabetics

Dear Oprah, It was Fun While it Lasted!


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It’s over between me and Oprah. If you are a regular reader of metabolism.com you probably know about my proposal to Oprah. Don’t get worked up, it wasn’t a marriage proposal. It was a proposal to create a Diabetes Lifestyles reality show for her new cable network. Here’s the background. Oprah is starting her “Own” network on cable and is hosting a contest for ideas to add to her line up. For the past 6 months visitors to Oprah’s website have been able to view all the ideas submitted by the public and vote for their favorite ones. My idea was to produce a Diabetes Lifestyle reality show called This Sweet Life. Over two months my idea acquired about 60 votes and was still in the running. The problem between Oprah and I started when she asked for a commitment. I’m not phobic about commitments but she asked for too much. In order to stay in the contest I had to commit to taking 6 weeks away from my medical practice to go to Los Angles to participate in filming of the conclusion of the contest. I’m sorry Oprah…I’m already committed to my medical practice so you can’t have me!

Maybe some other time. But it was fun while it lasted.

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

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Does Inflammation Caused by Obesity Result in Diabetes ?


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What comes to mind when considering the term “inflammation”? A festering pimple, or perhaps a high fever, an infected tooth, toe, abscess? These are typical examples of inflammation. Inflammation may exist in many other forms however, including possibly obesity.

Inflammation describes the immune system when it is activated. The presence of pus or fever are obvious forms of this. More subtle forms of inflammation can exist in the body. Recently, researchers from Australia, presented evidence that obesity itself is associated with abnormal activation of the immune system, or in other words, inflammation. This inflammation might in turn, cause type 2 diabetes. It is already becoming clear that the inflammation associated with obesity contributes to insulin resistance, the first step in the development of type 2 diabetes. In a study just published in the June volume of the Journal of Clinical Endocrinology and Metabolism (95:2845-2850, 2010), patients with either type 2 diabetes or pre-diabetes were evaluated for the distribution of inflammatory blood cells before and after gastric band surgery. Abnormal immune activation or inflammation was detected in this group. After an average of 13% weight loss following gastric surgery, the scientists found up to an 80% reduction in inflammatory blood cells. Many of the patients were able to significantly reduce their diabetic medications after the weight loss. The conclusion is that inflammation may result from obesity and is reversible when significant weight is lost. Metabolic problems like diabetes improve as the inflammation is reduced, as well. Therefore, inflammation may be part of the reason people develop diabetes as their weight increases.

Studies like this will provide new avenues for attacking the development of type 2 diabetes due to excessive weight gain, and possibly to help find ways of combating obesity, as well.

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

4 Days and 1 Million Votes to Go


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Well….we tried. Thanks to everyone who voted for my Diabetes Show idea for the Oprah channel. With only 40 votes so far and 4 days to go, there isn’t much hope of my idea getting recognized by the judges for the Oprah network contest.

I still think it would be great T.V. to have a behind the scenes and personal look at the lives of people with diabetes and their relationships with their health care providers.

Maybe someday I’ll get another opportunity to promote the idea.

Thanks again for those who supported the idea.

Dr. G. Pepper

Will Insomnia Lead to Diabetes?


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During the past decade researchers have discovered that lack of adequate sleep can cause metabolic defects similar to those of diabetes. Blood sugar tends to be higher and insulin resistance more pronounced in people who don’t get adequate sleep. To create these abnormalities in blood sugar metabolism for studies, researchers typically deprived subjects of sleep to an extreme degree for several days. Recent research however, showed that less drastic sleep deprivation can create the same diabetes-like problems in metabolism.

In a study just published in the June edition of the Journal of Clinical Endocrinology and Metabolism (95:2963-2968, 2010), researchers in the Netherlands allowed normal subjects to sleep for only 4 hours for a single night. They found that after one night of sleep deprivation the body was not able to respond nearly as well to insulin as after a normal night of sleep.

Can this type of sleep deprivation eventually lead to permanent blood sugar problems? A group of researchers from Columbia University found that people who habitually sleep less than 5 hours per night are twice as likely to develop diabetic levels of blood sugar compared to those who sleep more.

What is the connection between sleep deprivation and diabetes? The thought is that lack of sleep fosters an inflammatory environment in the body. Whether this is because during sleep the body removes inflammatory cells and toxins or whether sleeplessness increases the production of inflammatory agents is not known. Inflammation, in turn, creates the basic metabolic defect in type 2 diabetes known as insulin resistance. Since insulin is the hormone that regulates blood sugar, if the body is resistant to insulin than high blood sugar (diabetes) can develop.

Conclusion? Work and worry less, sleep better and longer, and reduce your risk of getting diabetes. (Did I hear you say he must be dreaming?)

This article is for educational purposes only and is not meant as medical advice or treatment.

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

Can Elevated Adrenal Hormone (Cortisol) Cause a Heart Attack?


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The adrenal glands sitting on top of the kidneys make several hormones critical to life. The central part of the adrenal makes the hormone we refer to as adrenalin, technically from the group known as catecholamines. This is the stress responsive hormone causing rapid heart rate, sweating, increased mental alertness, preparing the body for “fight or flight”. The outer portion of the adrenal makes the hormone cortisol, also known as cortisone. Cortisol maintains, among other things, the blood pressure, fluid and salt balance. Without sufficient cortisol production by the adrenals, life cannot be sustained. What is surprising is that excess cortisol can be as harmful to health as insufficient cortisol.

Deficient cortisol production is referred to as adrenal insufficiency (Addison’s disease is one form of this), while excess adrenal function is termed Cushing’s Syndrome. During certain types of stress such as severe infection the adrenal gland can produce up to 10 times the normal amount of cortisol. If cortisol levels remain elevated for prolonged periods of time the hormone’s destructive nature is revealed by the break down of soft tissue such as skin and muscle and weakening of the immune system with frequent and aggressive infections occurring sometimes with fatal outcome. Heart disease has not been associated with high cortisol levels until a recent study suggested this possibility.

Researchers from the U.K. examined morning cortisol levels in 1066 men and women with Type 2 diabetes participating in the Edinburgh Type 2 Diabetes Study. A positive relationship was discovered between cortisol levels and the occurrence of heart disease such as heart attack and angina. The higher the cortisol levels were the greater the risk of heart disease. Cortisol levels in diabetics were found to be higher than in non-diabetics, in general. The researchers could not explain why the cortisol levels caused heart disease or why levels were higher in diabetics. (From the April edition of the Journal of Clinical Endocrinology and Metabolism 95:1602-1608).

‘Adrenal fatigue’ is a recently proposed diagnosis used to explain a variety of general symptoms such as fatigue, moodiness, muscle aches, and diminished mental function. Supposedly, adrenal fatigue results from mild impairment of cortisol production. Practitioners who diagnose “adrenal fatigue” are prescribing synthetic versions of cortisol as treatment. The possibility of heart disease resulting from excess cortisol should be a factor that patients and medical professionals must consider before embarking on adrenal “supplementation” programs.

This information is for educational purposes only and is not intended as medical advice or treatment.

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

Inhaled Insulin – An alternative To Needles


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There are an estimated 16 million diabetics in the United States today. This number can be further subdivided into Type 1 (juvenile-onset) or Type 2 (adult-onset) diabetics. At the root of both types of diabetes is the inability to control levels of blood glucose, the main energy source for the human body. This is due to either a deficiency or developed insensitivity to insulin which mediates the uptake of glucose from the bloodstream into the cells.

There are many long term complications including stroke, heart disease, kidney disease, blindness, and loss of sensation in the limbs all due to an excess of glucose in the blood.

Fortunately, insulin therapy can delay the onset and slow the progress of complications of diabetes by as much as 35-60%. Insulin therapy currently involves either oral medications or subcutaneous self-injections. Injections are required for Type 1 diabetics and if oral medications fail in Type 2 diabetics.

Nevertheless, these injections can obviously be undesirable due to local discomfort and disruption of normal lifestyle. As a result, there has been constant research into alternative forms of insulin delivery. Recently, inhaled insulin has been gaining ground as a potential therapy. The pulmonary system with its extensive blood supply and easy access to the outside world would seem like an excellent candidate for drug administration. However, there have been many problems surrounding this form of delivery. Blood glucose must ideally be maintained throughout the day in the range of 64-112 mg/dL. This requires that a measured amount of insulin be administered on a time schedule centered around meals to provide adequate control. There must be consistency in the amount of insulin delivered and received by the body with each dosing.

The pulmonary system of people does not always exhibit this consistency due to the anatomical differences between individuals as well as differences in breathing patterns. One study in 1993 utilizing an aerosolized insulin preparation demonstrated this variability with a 43-71% decrease in glucose levels among 6 patients. Furthermore, the effect of inhaled insulin is rapid, but is not maintained.

In the same study of 1993, insulin absorption quickly peaked near 40 minutes while subcutaneous injections have a slow peak at 144 minutes. This slow peak and fall helps to maintain glucose levels appropriately whereas the fast peak and fall can initially send the patient into dangerously low levels of blood sugar and subsequently high levels before the next dose.

But that was in 1993 and aside from the Y2K bug, we have much to look forward to. Inhale Therapeutics System in partnership with Pfizer has created a novel form of pulmonary insulin and delivery system which has been demonstrated to have dose to dose consistency similar to injectable insulin with respect to the amount of insulin absorbed. The new portable aerosol delivery system is about the size of a flashlight and it converts a packet of fine insulin powder into an aerosol. The packaged powder is stable under a great range of environments including room temperature. One or two inhalations provides a therapeutic dose and it is mechanically operated without requiring an external power source.

Two studies were conducted comparing subcutaneous insulin versus inhaled insulin with measurements of HbA1c which is a measure of glucose control over the prior 2-3 months. The first study of 70 type 1 diabetics showed a decrease in Hb1Ac from 8.5% to 7.7% over 3 months in the injection group whereas the inhaled group averaged a decrease from 8.5% to 7.8%. In the second study of 50 patients with type 2 diabetes, the drop in Hb1AC over 3 months was virtually identical. The incidence of undesirably low blood glucose was similar in both the injection and inhalant groups, no changes were noted in the pulmonary function of subjects, and it was well tolerated.

Moreover, 80% of the type 1 participants and 92% of the type 2 participants who received inhaled insulin, opted to continue on the inhaled preparation. Nevertheless, patients were still required to take an injection at night before bedtime in order to maintain blood glucose levels throughout the night. Currently, inhaled insulin is in its last phase of testing before FDA submission and potential approval. If approved, it may provide a less painful means of controlling diabetes and preventing the dangerous outcomes for all diabetic patients.