Diabetes is about to become a concern for millions of middle-aged Americans who never gave it much thought before. The American Diabetes Association, backed by federal health authorities, recently called for routine screening of all Americans starting at age 45, using a simple, inexpensive test, in order to detect more cases of Type 2 diabetes earlier. This form of diabetes, previously called non-insulin dependent or adult-onset diabetes, accounts for 90 to 95% of cases of diabetes. Until now, the disease has generally been diagnosed when people develop symptoms, such as unusual thirst or frequent urination, or when people at high risk for the disease (such as those with a family history of it) are tested for it. Now blood sugar testing may become as routine as blood pressure screening.
At the same June meeting, the Association issued new guidelines that lower the cutoff points between normal, borderline, and high (diabetic) levels of blood sugar. That, combined with widespread screening, is expected to identify an additional 2 million Americans as diabetics. It’s estimated that 14 to 16 million have diabetes, but half have not been diagnosed. And the half that have been diagnosed typically have the disease for seven years before it is diagnosed. Experts hope that early detection will identify cases when they are still mild. It’s hoped that this way, before symptoms develop, people can take steps to minimize the subtle damage to organs and blood vessels caused by years of high blood sugar levels, and avoid later complications of diabetes, such as heart disease, hypertension, stroke, and diseases of the eyes, nerves, and kidneys, which often lead to premature death.
Diabetes is a breakdown in the body’s ability to utilize glucose (blood sugar) efficiently. Glucose, the main sugar into which foods are digested, can be used by our cells only in the presence of the hormone insulin. With Type 2 diabetes, the cells become resistant to the effects of insulin, and thus blood levels of glucose rise. (With Type 1, which is usually diagnosed in young people, the body virtually stops producing insulin.) The incidence of Type 2 diabetes is on the rise, largely because the U.S. population is aging and getting heavier.
The new guidelines
• If you are 45 or over, you should be tested every three years.
• You should be tested earlier and more frequently if you:
— are obese (more than 20% above healthy body weight). The obesity rate has risen dramatically during the past two decades and now includes one-third of Americans.
— have a parent or sibling with diabetes.
— are black, Hispanic, or Native American, or belong to another high-risk ethnic group.
— gave birth to a baby weighing more than nine pounds, or developed gestational diabetes during pregnancy.
— have high blood pressure (140/90 or higher).
— have an HDL (”good”) cholesterol level of 35 or below and/or a blood triglyceride level of 250 or higher.
• The ADA recommends the fasting plasma glucose test (no food for eight hours before) because it is simplest, cheapest (about $10), and most likely to be utilized on a regular basis. The same vial of blood drawn for the test can also be used to measure cholesterol and for other standard blood work, if needed.
• A result of 126 mg/dl (milligrams of glucose in one-tenth liter of blood) or more, confirmed on a second day, means you have diabetes. The former guidelines set the cutoff at 140. Researchers now believe that serious problems linked to diabetes begin with test results in the mid-120s.
BLOOD SUGAR (mg/dl) DIAGNOSIS
Less than 110 Normal
110-125 Impaired fasting glucose
126 and above (twice) Diabetes
• If you are diagnosed with diabetes in its early stages, you’ll be advised to lose weight if you’re overweight, exercise more, improve your diet (choose the same low-fat, semi-vegetarian diet that is known to lower the risk of heart disease and cancer), and quit smoking if you smoke. The goal of early detection is to avoid diabetes medications, or at least postpone or minimize their use, not merely to start drug therapy earlier.
• If your result is between 110 and 125, you fall into a new category called “impaired fasting glucose,” a danger zone or borderline area. This means that you should take the same steps as outlined above, since blood sugar levels tend to rise with age. Here is where it may truly be possible to prevent diabetes. (For more about a diabetes-prevention diet, see the article below).
Last words: Unfortunately, there’s no clear evidence that earlier treatment with drugs will reduce the long-term complications of Type 2 diabetes (though it does for Type 1). Next year the results of a major ongoing British study may provide this evidence. In any case, if screening for diabetes serves as an additional incentive for people to make life-style changes (such as losing weight and exercising), that can only be beneficial.
Diabetes Prevention: The Diet
Many people still believe that eating too much sugar causes diabetes. This misconception arises because diabetes is diagnosed by measuring blood sugar (glucose). But dietary sugar is only part of the picture. According to two recent Harvard studies, a diet rich in certain high-carbohydrate foods—those low in fiber and with a high glycemic index (see below)—increases the risk of Type 2 diabetes, at least in those predisposed to it.
One study tracked 65,000 female nurses (age 40 to 65); the other followed 43,000 male health professionals. Over the course of six years, a total of 1,438 developed diabetes. Men and women whose diet had a high glycemic index and low fiber content more than doubled their chance of developing diabetes. Foods that seemed to pose the greatest risk were white bread, white rice, potatoes, and sugary soft drinks. In contrast, whole-grain breads and cereals (rich in fiber and with a lower glycemic index) appeared to reduce the risk of diabetes. Fruits and vegetables didn’t seem to have an effect, good or bad.
The researchers suggested that excessive amounts of carbohydrate-rich foods with a high glycemic index put pressure on the pancreas to produce more of the hormone insulin, which stimulates the body’s cells to take in and store glucose. Over time, the body may become resistant to insulin. In such insulin-resistant people, the cells become less and less sensitive to insulin. This is characteristic of Type 2 diabetes. Of course, not everyone on such a low-fiber, high-starch diet develops diabetes. There seems to be a genetic predisposition to diabetes, which may be exacerbated by this kind of diet. Without these dietary factors, the men and women in these two studies might have developed diabetes later in life, or perhaps not at all.
Obesity is probably the leading risk factor for Type 2 diabetes. Family history of the disease, advancing age, and lack of exercise are other important factors.
Magnesium helps, too
The study also found that the mineral magnesium has a protective effect against diabetes. A few studies have suggested that this mineral improves insulin sensitivity. But since whole grains are rich in magnesium, it’s hard to say whether the proposed benefit is due to something else in the grain (notably its fiber) or the mineral.
Bottom line: A diabetes-prevention diet, if there is one, is the same low-fat, high-fiber, semi-vegetarian diet that is known to lower the risk of heart disease and cancer. The Harvard studies simply underline the importance of choosing whole-grain products, as opposed to highly refined, low-fiber grain products such as white bread, in order to help control blood sugar. Such a diet helps in weight control. It also provides the vitamins, minerals, and other nutrients you need to help prevent chronic diseases, including, perhaps, diabetes.
How is it used?
NIH Risk Assessment Calculator Cholesterol is different from most tests in that it is not used to diagnose or monitor a disease but is used to estimate risk of developing a disease — specifically heart disease. Because high blood cholesterol has been associated with hardening of the arteries, heart disease and a raised risk of death from heart attacks, cholesterol testing is considered a routine part of preventive health care.
When is it ordered?
Cholesterol Test Reminder link Cholesterol testing is recommended as a screening test to be done on all adults at least once every five years. It is frequently done in conjunction with a routine physical exam. It is usually ordered in combination with other tests including HDL, LDL, and triglycerides — often called a lipid profile.
Cholesterol is tested at more frequent intervals (often several times per year) in patients who have been prescribed diet and/or drugs to lower their cholesterol. The test is used to track how well these measures are succeeding in lowering cholesterol to desired levels and in turn lowering the risk of developing heart disease.
What does the test result mean?
In a routine setting where testing is done to screen for risk, the test results are grouped in three categories of risk:
* Desirable : A cholesterol below 200 mg/dL (5.18 mmol/L) is considered desirable and reflects a low risk of heart disease.
* Borderline high: A cholesterol of 200 to 240 mg/dL (5.18 to 6.22 mmol/L) is considered to reflect moderate risk. Your doctor may decide to order a lipid profile to see if your high cholesterol is bad cholesterol (high LDL) or good cholesterol (high HDL). Depending on the results of the lipid profile (and any other risk factors you may have) your doctor will decide what to do.
* High Risk: A cholesterol above 240 mg/dL (6.22 mmol/L) is considered high risk. Your doctor may order a lipid profile (as well as other tests) to try to determine the cause of your high cholesterol. Once the cause is known, an appropriate treatment will be prescribed.
In a treatment setting, testing is used to see how much cholesterol is decreasing as a result of treatment. The goal for the amount of change or the final (target) value will be set by your doctor. The target value is usually based on LDL.
Is there anything else I should know?
Cholesterol should be measured when a person is healthy. Blood cholesterol is temporarily low during acute illness, immediately following a heart attack, or during stress (like from surgery or an accident). You should wait at least 6 weeks after any illness to have cholesterol measured.
There is some debate about whether very low cholesterol is bad. Low cholesterol (less than 100 mg/dL (2.59 mmol/L)) is often seen when there is an existing problem like malnutrition, liver disease, or cancer. However there is no evidence that low cholesterol causes any of these problems.
Cholesterol is high during pregnancy. Women should wait at least six weeks after the baby is born to have cholesterol measured.
Some drugs that are known to increase cholesterol levels include anabolic steroids, beta blockers, epinephrine, oral contraceptives, and vitamin D.
I knew some of my friends were getting tested for colon cancer. But I didn’t think it was very important because no one in my family has had colon cancer. Then a good friend of mine was diagnosed with colon cancer and had no family history of it. So I decided to ask my doctor about colon cancer testing. She told me that all people over age 50 need to be tested and then continue to be tested every 5-10 years, depending upon their situation.
— Sam O. Breast Cancer
As women get older, their chances of getting breast cancer increase. In fact, most breast cancers occur in women over the age of 50.
Research shows that the best way to find breast cancer is to get a mammogram. This is an x-ray test that can find a breast cancer when it is so small that it cannot be felt. Most breast cancers are treated more easily when found early.
All women aged 50 and older should have a mammogram every 1 to 2 years. This recommendation is based on scientific evidence. Ask your doctor how often you need a mammogram. Make sure to tell your doctor if your mother or a sister has had breast cancer. If so, you may need to have mammograms more often than other women. Your doctor may also examine your breasts.
Ask your doctor:
Square bullet image How often do I need a mammogram?
Keep track of your mammograms. Use your cancer test chart .
Cancer of the Cervix
All sexually active women are at risk for cancer of the cervix. Most deaths from cancer of the cervix can be prevented if the cancer is found and treated early. A Pap test can find cancer of the cervix early—while it’s easier to cure. This simple test saves lives.
Based on scientific evidence, women need to have a Pap test every 3 years, some more often. Set a date with your doctor to get a Pap test.
Your doctor may suggest stopping Pap tests if:
Square bullet image You are over age 65 and have had regular, normal Pap tests.
Square bullet image You have had a hysterectomy.
Tell your doctor if you have had genital warts, a sexually transmitted disease (STD), multiple sex partners, or abnormal Pap tests. If so, you may need Pap tests more often than other women.
Ask your doctor:
Square bullet image How often do I need a Pap test?
Keep track of your Pap tests. Use your cancer test chart.
Colon cancer is the second leading cause of death from cancer. Older men and women are more likely to get colon cancer than those who are younger. But if caught early, colon cancer can be treated more easily. Effective tests are available to find colon cancer. However, many people do not take advantage of these tests.
Starting at age 50, you should have tests to detect colon cancer. This advice is based on scientific research. The tests you may have are:
Fecal Occult Blood Test—To test for small amounts of blood in your stool. This test should be done yearly.
Sigmoidoscopy—To look inside the rectum and colon using a small, lighted tube. Your doctor will do this in the office or clinic. This test should be done once every 5 to 10 years. Tell your doctor if you have had polyps or if you have family member(s) with cancer of the colon, intestine, breast, ovaries, or uterus. If so, you may need to be tested more often.
Ask your doctor:
Square bullet image How often do I need these tests?
Keep track of your tests. Use your cancer test chart .
Oral cancer includes cancers of the lip, tongue, pharynx, and mouth. Most oral cancers occur in people over age 40 who use tobacco or alcohol. People who are in the sun a lot also are at risk for cancer of the lip.
If you chew or smoke tobacco and drink a lot of alcohol, you may want your dentist to examine your mouth for signs of oral cancer during your regular dental checkup. You may also need to see your dentist more often.
Scientific evidence shows that you can help prevent oral cancer by not smoking and cutting back on the amount of alcohol you drink. If you are outdoors a lot, you should use a sunblock on your lips.
Ask your health care provider:
Square bullet image How often should I get dental checkups?
Keep track of your dental visits. Use your cancer test chart .
Prostate cancer is most common in men over age 50, in African Americans, and in men with a family history of prostate cancer.
Tests such as a rectal exam and PSA (prostate-specific antigen) blood test can help detect prostate cancer. Based on research, it is not yet clear whether these tests save lives.
Ask your doctor:
Square bullet image What are the pros and cons of tests for prostate cancer?
Skin cancer is the most common type of cancer in the United States. Most skin cancers can be cured, especially if they are found and treated early.
You may need to have your doctor examine your skin if:
Square bullet image You have many moles (large freckles).
Square bullet image You have been in the sun a lot.
Ways to help prevent skin cancer:
Square bullet image Limit the amount of time you spend in the sun, especially between the hours of 10:00 a.m. and 3:00 p.m.
Square bullet image Wear clothing that protects you from the sun.
The list of types of Anemia mentioned in various sources includes:
* Iron deficiency anemia - the most common cause.
* Sickle Cell Anemia
* Autoimmune Hemolytic Anemia
* Pernicious anemia
* Categories of anemias:
o Microcytic hypochromic anemia - about 90% of cases
o Megaloblastic hyperchromic anemia - about 7% of cases; immature megaloblast cells wrongly enter the blood.
o Aplastic anemia - bone marrow not producing enough red blood cells.
o Hemolytic anemia - caused by early destruction of red blood cells in the blood.
There are several kinds of anemia produced by a variety of underlying causes, but the most common and most severe type of anemia, iron-deficiency anemia (IDA). Just as the name implies, this form of anemia is due to insufficient iron. In the United States, 20% of all women of childbearing age have iron-deficiency anemia, compared with only 2% of adult men. The principal cause of iron-deficiency anemia in premenopausal women is blood lost during menses. (Source: excerpt from Anemia: NWHIC)
Allergy blood tests look for substances in the blood called antibodies. Blood tests are not as sensitive as skin tests but are often used for people who are not able to have skin tests.
The most common type of blood test used is the enzyme-linked immunosorbent assay (ELISA, EIA). It measures the blood level of a type of antibody (called immunoglobulin E, or IgE) that the body may make in response to certain allergens. IgE levels are often higher in people who have allergies or asthma.
Other lab testing methods, such as radioallergosorbent testing (RAST) or an immunoassay capture test (ImmunoCAP, UniCAP, or Pharmacia CAP), may be used to provide more information.
Allergy testing involves having a skin or blood test to find out what substance, or allergen, may trigger an allergic response in a person. Skin tests are usually done because they are rapid, reliable, and generally less expensive than blood tests, but either type of test may be used.
A small amount of a suspected allergen is placed on or below the skin to see if a reaction develops. There are three types of skin tests:
* Skin prick test. This test is done by placing a drop of a solution containing a possible allergen on the skin, and a series of scratches or needle pricks allows the solution to enter the skin. If the skin develops a red, raised itchy area (called a wheal), it usually means that the person is allergic to that allergen. This is called a positive reaction.
* Intradermal test. During this test, a small amount of the allergen solution is injected into the skin. An intradermal allergy test may be done when a substance does not cause a reaction in the skin prick test but is still suspected as an allergen for that person. The intradermal test is more sensitive than the skin prick test but is more often positive in people who do not have symptoms to that allergen (false-positive test results).
* Skin patch test. For a skin patch test, the allergen solution is placed on a pad that is taped to the skin for 24 to 72 hours. This test is used to detect a skin allergy called contact dermatitis.
Glossary Terms for Allergies
Alcohol is a drug that effects the central nervous system.
Impairment from alcohol poisoning was originally defined by blood alcohol levels. It was observed that most people showed measurable mental impairment at around 0.05% blood alcohol concentration (BAC). Above this level it has been found that motor functions deteriorate progressively with increased blood alcohol concentrations. For the average person, unconsciousness results by 0.4% BAC. Above 0.5% (BAC), basic body functions such as the breathing or the beating action of the heart can be depressed to the point that death can occur.
Blood was the medium originally used to measure alcohol concentrations in the human body. Blood tests offer the ability to accurately test the same sample several times, if the sample is maintained properly. The disadvantages with blood analysis is that the collection process requires trained medical personnel, the sample collection is invasive, the analysis requires precise procedures by trained lab technicians , the results are not immediately available and the overall process is costly.
In the 1930’s the pioneers in the development of breath alcohol testing took advantage of the fact that alcohol was found in the deep lung breath in proportion the alcohol found in the blood. Breath testing instruments were manufactured to capture a sample of alveolar breath for analyses. Some of the early instruments were crude, but today breath analytical instruments have evolved into low cost, highly accurate, rapid analytical systems that simply and painlessly collect a sample and calculate a result. Although a trained operator is still required, the collection and analysis process is simple. Additionally, many jurisdictions have defined alcohol in terms of breath instead of blood so that an extrapolation to blood in order to determine impairment is no longer necessary.
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