Pre-Diabetes: One in Four Americans Have It

It is estimated that one fourth of the US population has pre-diabetes - that's 54 million people. The findings reported in the November 7th, Morbidity and Mortality Weekly Report states that as many as one in four Americans have this condition and only 4% are aware of it.

Pre-diabetes is defined as having fasting blood sugars between 100-125 mg/dl. Normal blood sugar should be between 60-99 mg/dl after fasting. Pre-diabetes or impaired fasting glucose as it is now more commonly referred to is a precursor condition for diabetes. As many as 50% of those with impaired fasting glucose will become diabetic and 15% will progress to diabetes within five years. Unless drastic measures are taken it is estimated that one in three people born after the year 2000 will be diabetic.

This is a treatable condition, however, and progression to diabetes is not inevitable. Recent studies have shown that 150 minutes of exercise per week (that's only 30 minutes a day 5 days a week) decreases your risk of progression by nearly 70%.

What is your risk for pre-diabetes? Take the following screening test and find out:
Age: Score:
20-27 . . . . . . . . . . . 0
28-35 . . . . . . . . . . . 1
26-44 . . . . . . . . . . . 2
45-64 . . . . . . . . . . . 3

Sex:
Male . . . . . . . . . . . . 3
Female . . . . . . . . . . 0

Body Mass Index:
Less than 25 . . . . . 0
25-29.9 . . . . . . . . . .2
30 or greater . . . . . 3

Family History of Diabetes:
No . . . . . . . . . . . . . . 0
Yes . . . . . . . . . . . . . .1

Heart Rate (bpm)
Less than 60 . . . . . . 0
60-69 . . . . . . . . . . . . 1
70-79 . . . . . . . . . . . . .1
80-89 . . . . . . . . . . . . 2
90-99 . . . . . . . . . . . . 2
> 100 . . . . . . . . . . . . 4

Hypertension:
No . . . . . . . . . . . . . . . 0
Yes . . . . . . . . . . . . . . .1

Add up the score in each area. If your number is 7 or more, you need to be screened.

Again the key in prevention is exercise. Just a simple 30 minute walk 5 times per week is all it takes.

Death by Caffeine

I drank a wonderful cup of hot chocolate this evening while watching a nice Christmas movie with my wife and children. Now, I sit here at my computer at 1am wondering why I am not tired. . . and I realize it is the caffeine ingested with that wonderfully smooth and chocolaty hot cocoa. This got me to wondering . . . how long is this going to be in my system?

Well, the half-life of caffeine is about 6-8 hours. That means it takes up to 36 hours for your body to metabolize the caffeine and remove 95% of it from your system and it takes another 36 hours to completely remove it. Will I still be sitting here on my computer in 6 days? I hope not.

Caffeine is metabolized or broken down in the liver by the cytochrome P450 oxidase enzyme (This is the same metabolic component important in steroid synthesis) system into three metabolic dimethylxanthines, which each have their own effects on the body:
Paraxanthine (84%): Has the effect of increasing lipolysis, leading to elevated glycerol and free fatty acid levels in the blood plasma.
Theobromine (12%): Dilates blood vessels and increases urine volume. Theobromine is also the principal alkaloid in cocoa, and therefore chocolate.
Theophylline (4%): Relaxes smooth muscles of the bronchi, and is used to treat asthma. The therapeutic dose of theophylline, however, is many times greater than the levels attained from caffeine metabolism.
Each of these metabolites is further metabolized and then excreted in the urine.

The interesting effect of all this is that caffeine secondarily stimulates insulin secretion which then lowers blood sugar, thereby stimulating hunger. This can cause weight gain. Caffeine, inhibiting the Cytochrome P450 system also can effect steroid synthesis and can lead to lower testosterone levels and weight gain. Funny isn't it? Caffeine sold in all the weight loss products has just the opposite effect on weight - it will cause you to gain weight.

So, how much caffeine is really problematic? Well, physicians use caffeine to help with fatigue and to help with cognition (your ability to think clearly). However, only 100-200mg are needed to have these effects. The precise amount of caffeine necessary to produce effects varies from person to person depending on body size and degree of tolerance to caffeine. It takes less than an hour for caffeine to begin affecting the body and a mild dose wears off in three to four hours. Consumption of caffeine does not eliminate the need for sleep: it only temporarily reduces the sensation of being tired.

250-700mg of caffeine in your system can, and often does, cause anxiety, nervousness, hypertension, and insomnia (you are probably reading this at 1am because of your hot chocolate, too, aren't you!?) Caffeine relaxes the internal anal sphincter muscles and thus should be avoided by those with fecal incontinence. (I now understand why they never serve caffeinated drinks at and open house for a proctologist).

Caffeine has a drastic effect on spiders as you can see. The picture is the same spider "caffeine free" on top and "caffeinated" on the bottom.

Greater than 1000mg of caffeine will often cause tachycardia (rapid heart rate over 110 bpm), heart palpitations (the sensation of your heart pounding or beating heavily in your chest), insomnia, tinnitus (ringing in the ears), cognitive difficulty (cloudy thinking).

How much caffeine is too much? Well, over 10 grams is lethal. Yes, caffeine can kill you . . . literally.

So how much caffeine did I get in my cup of hot chocolate? Well, I drank about 10 oz and that contains roughly 0.6mg per oz. I don't drink caffeine very often and so that 6-7mg is actually affecting me and has given me a short burst of energy (not to mention the sugar content of the hot cocoa - that's for another nights blogging). Here's a list of common drinks and their caffeine content, just in case you wanted to know:

Amount/ Product/ Caffeine content:

12 oz Most cola drinks. . . . . . . . . . . . . . . . . .40-100mg

8 oz Hot Cocoa . . . . . . . . . . . . . . . . . . . . . . . .5mg

1 cup Espresso. . . . . . . . . . . . . . . . . . . . . . . .200mg

6 oz Coffee (American). . . . . . . . . . . . . . . . .100mg

1 cup Instant Coffee . . . . . . . . . . . . . . . . . . .75mg

1 cup Decaff Coffee. . . . . . . . . . . . . . . . . . . . 3mg

16 oz Rock Star. . . . . . . . . . . . . . . . . . . . . . . 300mg

1 cup Starbucks Grand Coffee. . . . . . . . . . .360mg

1 cup Tea. . . . . . . . . . . . . . . . . . . . . . . . . . . . 60mg

4 oz Chocolate bar. . . . . . . . . . . . . . . . . . . . .80mg

1 Excedrin. . . . . . . . . . . . . . . . . . . . . . . . . . 65mg

1 Midol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32mg

1 No-Doz. . . . . . . . . . . . . . . . . . . . . . . . . . . . .100mg

Well, for what it is worth, I think I will save my next cup of hot chocolate for next Christmas.

I am going to go find the Benadryl . . . right after I find the bathroom . . .

Recommendations for General Health

I am often asked "how often should I have a physical and what should it include?" In response to this question the following things should be considered realizing that this is not a comprehensive list and each item should be discussed with your doctor.

First, it is recommended that you have a physical exam at least yearly. A physical exam or "physical" is an opportunity for your physician to review all of you body systems and identify your risk for major diseases and more significantly identify ways to prevent these diseases.

A "physical" should routinely include a head to toe exam including vital signs (blood pressure, pulse, respirations, and temperature) and a vision screening. This should include an examination of your eyes, ears, nose, throat, neck, heart, lungs, abdomen, genitourinary systems and extremities. If you are over the age of 30, this should routinely include an EKG (Electrocardiogram). This exam should also include basic blood work including a complete blood count, comprehensive metabolic panel, thyroid stimulating hormone level, urinalysis and fasting lipid (cholestero) panel.

If you are a smoker or have any history of lung diseases including asthma, emphesema or chronic bronchitis, you should have a yearly chest x-ray.

Men between the ages of 40 and 70 years old should have a prostate exam yearly and this should include a PSA (Prostate Specific Antigen) blood test to screen for prostate cancer.

Women who are sexually active or over the age of 18 should have a yearly pap smear to screen for human papilloma virus (HPV) and cervical cancer.

Men and women over the age of 50 should have a screening colonoscopy every 10 years to check for colon cancer.

Women over age 40 should have yearly mammograms, and women who are menopausal or who have had a hysterectomy should have a bone densometry test every 2 years.

During your physical exam the following vaccinations can be considered:

Influenza - yearly for the very young and for those over the age of 65 or with any lung disease

Pneumonia - every 5 years.

Hepatitis B - anyone with freqent exposure to the public or any healthcare worker

Hepatitis A - anyone with freqent exposure to the public, healthcare or daycare worker.

The following vaccines are very helpful but you should talk to your doctor about risks and benefits of their use:

Guardasil - Vaccine for prevention of Human Papilloma Virus

Zostavax - Vaccine for prevention of Herpes Zoster (Shingles).

It is recommended that most people without significant complicating illness eat a diet low in fat and exercise for 30 minutes at least 3 times per week to maintain their level of health.

For specific information on medical problems or symptoms, please see your doctor.

Welcome

This is the first in a series of articles and remarks about current medical topics affecting the practice of medicine.