14
November
2007
Type 2 Diabetes means the body is resistant to insulin. The body makes insulin, but usually due to obesity the body doesn’t respond to insulin well anymore. So the pancreas cranks out more and more insulin to compensate for this need, but in time it is not enough.
Over 7% American adults have diabetes. Since 1990 Type II diabetes has been dramatically increasing in children and adolescents due to obesity. 14% of US health care costs are from diabetes. Overall costs to USA is about 132 billion dollars as of 2002. Fasting blood glucose of 126 or more is diabetes, or a HbA1C of 6% or more.
So, Januvia (sitagliptin) has been out in the market for over the past year to help those with Type II diabetes who aren’t getting enough control on metformin (a commonly used medicine for type 2 diabetes). So what is it? Oh, boy, here is my best explanation.
Incretins are intestinal hormones that are released when there is food in the gut. Incretins GLP-1 (glucoagon-like peptide-1) and GIP (glucose-dependent insulinotropic peptide) do the following: lowers glucagon secretion, slows the GI system, and increases satiety. Also they stimulate secretion of insulin
Dipeptidyl peptidase-4 (DDP-4) “digests” GLP-1 and GIP, so Januvia inhibits
drjohnhong 
diabetes, Endocrinology 
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22
August
2007
Vitamin D deficiency is more prevalent than ever, probably because we don’t get enough sunlight. But with Mr. Ozone disappearing like characters on Lost, we are intentionally avoiding the sun to prevent skin cancer. Vitamin D isn’t really in a lot of foods, so ultraviolet B radiation is/was a major way to convert 7-dehydrocholesterol to previtamin D3 (it takes a series of step for the body to make active vitamin D which is called 1,25-dihydroxyvitamin D). It is estimated 1 billion people have either vitamin D deficiency or insufficiency, in particular those who live in northern climates. More than half women who are past menopause, osteoporotic, and on meds for bones are vitamin D deficient. Nearly half kids and younger adults have vitamin D deficiency by the end of winter.
Vitamin D is necessary for healthy bones, and it seems for many other organs. The body absorbs calcium and phosphorus in the gut much better with assistance of vitamin D. Also if vitamin D gets low, parathyroid hormone rises and that can thin out the bones.
25-hydroxy vitamin D is what is measured to see a person’s vitamin D level. 20-100 is considered normal though most studies in the NEJM 2007;357:266-81 article lean towards 40-100. <20 is deficiency and 20-39 seems insufficiency. Greater than 100 and definitely more than 150 is vitamin D toxicity
Foods that have vitamin Vitamin D – eh, not very many. Fresh wild salmon 3.5oz has 600-1000IU of vitamin D which is a healthy daily dose for most. Farmed raised salmon only has 100-250IU. Cod liver oil 1tsp has 400-1000IU – just like what I saw on The Waltons when the nurse practitioner tried to prevent rickets in the children. 1 serving of fortified milk, fortified OJ, infant formulas, fortified yogurt (8oz, not 6), fortified cheeses (3oz), and fortified breakfast cereals have 100IU of vitamin D.
But for those who don’t get enough sun exposure, it appears 800IU of vitamin D is what is needed to keep levels in good range. So over the counter vitamin D might be required. Rx vitamin D is also available for those in particular with osteoporosis or osteomalacia.
Osteomalacia means the quality of the bone is not healthy and that can cause bone pain. So there is an observation of people with bone pain who feel better once repleted with vitamin D.
Brain, prostate, breast, colon and muscles have vitamin D receptors. So there is also an observation of decreased muscle pain and less falling down with replacement of vitamin D in those who were deficient or insufficient. Also the immune system appears to work poorly if there is vitamin D and even a correlation of Type I diabetes with vitamin D deficiency. Tuberculosis appears to be more prevalent in those who are vitamin D deficient, such as in African Americans in northern climates. Arthritis appears to be improved with vitamin D levels in good standing. The NEJM also talks about other disorders that are associated with vitamin D but they appears to be weak links such has depression, schizophrenia, hypertension, heart disease, multiple sclerosis, and cancer.
Besides lack of sun exposure, there are some genetic causes or illnesses that can lead to vitamin D deficiency. Medicines that can destroy vitamin D include HIV medications, anticonvulsants, and glucocorticoids. Other things that can lead to vitamin D deficiency include: well, sunscreen, darker skin due to melanin, winter time, kidney disease, liver disease, and malabsorption syndromes
drjohnhong Uncategorized, food, Bones & Muscles, Endocrinology Comments (0) » |
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