What tests diagnose diabetes?

 I am a 43-year-old female and I want to be tested for diabetes. What tests diagnose diabetes?

The diagnosis of diabetes mellitus is made by a blood (serum) glucose test. For non-pregnant adults a blood glucose level above 126 mg/dL before eating in the morning is considered diagnostic of diabetes mellitus. A blood glucose level over 200 mg/dL at any time will also make the diagnosis. Keep in mind that certain medications, stressful experiences such as acute illness or surgery may elevate the blood glucose levels. Persons with diabetes will frequently be complaining of thirst causing them to drink plenty of fluids and to urinate frequently, even interrupting their sleep. 

The distinction between prediabetes and diabetes is best made when the person is afebrile , not menstruating and preferably tested in the morning. A glucose challenge test using a sweet beverage with 75 g of glucose is sometimes ordered to confirm the diagnosis with blood drawn before the drink and 2 hrs after consuming it. 

Alternatively, some physicians rely on a hemoglobin A1c (HbA1c) test, which reflects a blood glucose average of the previous 3 months. A result greater than 6.5 % is considered diagnostic for diabetes. I prefer to confirm HbA1c results with blood glucose testing, as described, since the diagnosis of diabetes mellitus has very serious implications for both the patient and their health record. 

What are the treatment options for hypothyroidism?

I'm 40 years old, and I was diagnosed with hypothyroidism by my doctor just a few days ago. My doctor hasn't discussed the treatment options with me yet. How is this usually treated?

Hypothyroidism is a condition where the thyroid gland cannot produce adequate amounts of hormone to meet needs in the body. The diagnosis is made with special testing (TSH test). Thyroid hormone is replaced with a synthetic 'replica' or by hormone from animal sources. Levothyroxine , also known as T4, is usually prescribed and the body converts it to the active form known as  T3. In some cases , we prescribe both active T3 and T4 in combination. This may be the situation in persons who find that their energy level and other symptoms do not improve, even if testing shows that the dose of T4 prescribed is adequate. Your doctor will complete proper testing and monitor your progress on one of these options. They will decide if a brand name product or a generic preparation are the most appropriate for you. 

Should I be concerned about it when my mother and grandmother have diabetes?

Diabetes mellitus type 2 (insulin resistance)  in first degree relatives would classify you as having increased risk for developing diabetes. This means that periodic (at least annual) screening with glucose testing and HbA1c measurement are indicated. Diet and exercise are the best strategy for prevention. 

Diabetes mellitus type 1 (insulin dependent) in a first degree relative is much less likely to suggest that you are at risk for diabetes.  It usually is associated with antibodies against insulin-producing cells in the pancreas.

Can being on too much thyroid medicine cause quick episodes of dizziness?

 

Thyroid hormone  supplements can cause a rapid hear rate and palpitations if dosed in excess. Anxiety and dizziness can result from such experiences. Treatment with thyroid hormone involves selecting the right preparation and dosing it accurately with blood testing under medical supervision. Be aware that thyroid hormone products on the market may also contain other ingredients in their tablets which can cause an allergic response.

Hb1Ac test?

 My Hb1Ac is 5.2 %  do I need to take diabetic medicine?

Diabetes medications are generally reserved for people who have diagnosed diabetes mellitus (HbA1c score over 6.5 % or a  fasting glucose level over 126 mg/dl). If you have have diabetes and  have achieved the HbA1c level of 5.2 % with medication you should make changes only with the approval of your doctor. If you are interested in diabetes prevention, you do not need to rely on medication. Diet and regular exercise to control weight are widely accepted as the most important diabetes prevention measures. A HbA1c of 5.2% is considered to be in the normal range for the general population. Healthy lifestyle under proper professional supervision is the approach I recommend to all of my patients. 

If my mother has diabetes am I guaranteed to have it later in life?

Type 2 diabetes, which is non-insulin dependent, is more likely to be seen in successive generations due to genetics. Avoiding excessive weight gain, remaining physically active and consuming a healthy diet help in preventing diabetes mellitus type 2. Your health care provider should monitor your blood tests (glucose level, hemoglobin A1c) to alert you if critical thresholds are exceeded and to guide you in prevention. Vitamin D is an important supplement which supports cells in your pancreas that produce insulin. 

Can diabetes cause weight loss?

My husband has been diagnosed with diabetes 3 months ago and he has lost 20 pounds since then. What should we do?

In poorly controlled diabetes the insulin supply which regulates the proper utilization of nutrients involved in growth is deficient. Food ingredients that normally would serve to grow tissue and give us strength are wasted, usually  lost in the urine. The cellular machinery that serves to process the sugar , protein and fat from our diet malfunctions without adequate insulin in the mix. Patients lose weight and strength. Brain function is affected  and people's concentration, memory and mood suffer. Insulin supply should be restored either by administering insulin or by prescribing medication that improves the body's insulin production and insulin activity. Weight gain will result. Care must be exercised because too much insulin can promote obesity. 

COVID-19 and Diabetes

Patients with diabetes are a high risk group for infection when considering communicable illness and this applies to the Corona virus (COVID 19) currently afflicting the population.

The Corona viruses are familiar to us from previous epidemics in the United States (SARS, MERS) . This latest arrival on our shores has features similar to other Corona family members, but also appears very hardy in being able to survive on some surfaces for days, increasing the likelihood of infection. The family name Corona comes from spikes on the virus that permit it to easily attach to cell surface receptors so that proteins from its envelope and membrane can penetrate and take over the cell machinery. Inside the cell the nucleocapsid (RNA) possesses the information that transforms our cells into factories replicating the virus and releasing its copies into our system to spread the infection in the airways and lung tissue.

The body protects itself through its immune system mobilizing killer cells , antibodies and  chemicals. The immune reaction also involves secretion of gelatinous fluids from our tissues to bind the invaders and delay their progression. In many cases, this response can become part of the problem since fluid-filled airways in individuals weakened by chronic illness or excess weight can exceed their ability to control events and maintain oxygen supply. In such circumstances ventilator support may become necessary as the body struggles to survive the spread of virus throughout the body. Older patients are at greatest risk for unfavorable outcomes. 

Our best defense is prevention. I advise my patients to be well rested and to enjoy balanced meals properly timed respecting our biological clock (see my book A Blueprint for Healthy Eating: Your Diet Guide for the New Millennium). I add vitamin D and zinc to their regimen. These supplements support the immune system and fight inflammation preventing events from spiraling out of control. Certain familiar medications such as hydroxychloroquine  in combination with antibiotics have proven useful in arresting progression of the illness, always under careful medical supervision. Early intervention guarantees the best prospect for recovery.

Screening for the virus is important to identify carriers who have become exposed and can spread the infection without developing symptoms themselves. Measures can be taken to place them under observation for a few weeks before permitting them to meet or serve the public. Those individuals who have developed a fever or other symptoms of a cold can be screened  so that intervention can begin early.

As always , proper hygiene is essential in preventing infection. Decontaminating surfaces, shopping carts and shared devices is important. Seats in mass transit must be regularly sanitized and circulating air must be fresh and clean.  Most importantly, we must avail ourselves of the healing effects of sunlight with every opportunity. Ultraviolet sun rays are the disinfectant of choice in our environment and the generator of vitamin D in our skin.  Face masks and social distancing are also helpful in closed spaces and will remain part of our lifestyle for some time to come. 

What can diabetics with high blood pressure eat?

I am a 40 year old male. I have diabetes type 2 and high blood pressure. What can diabetics with high blood pressure eat?

Diabetes mellitus and high blood pressure are a dangerous combination which poses a threat to the body's blood vessels and may lead to kidney damage,  strokes and worse. 

Salt (sodium) does not exceed is the element in the diet that boosts blood pressure and complicates high blood pressure management. A low salt diet is advisable. Salt substitutes may be used for flavoring. 

Chips, pretzels, salted nuts, cold cuts, Chinese specialties and many processed foods have a high salt content and should be avoided. Diuretics used to lower blood pressure act by flushing salt out of the body. It would be unwise to eat salty foods and then use medication to get rid of it. I advise the public to read food labels and focus on sodium content per serving. Patients with hypertension should make sure their daily sodium consumption does not exceed 2000 mg.

I am having a lot of pain in my legs. Could it be diabetic neuropathy?

The typical leg pain associated with diabetic neuropathy usually presents as burning or 'pins and needles' or even numbness in 'stocking ' distribution involving both legs. It invariably is more intense overnight and may disturb sleep.  Sharp pains radiating down the leg from the thigh or lower back would suggest nerve root irritation and would more likely be attributable to problems in the spine. 

Does Metformin ensure that I won't have diabetes because of my PCOD?

Metformin is frequently prescribed for patients with polycystic ovary syndrome because it improves insulin sensitivity and restores menstrual regularity. It has also been shown to benefit fertility and may protect the pregnancy once the woman has conceived. Women with polycystic ovary syndrome are characterized by significant insulin resistance which may lead them to develop diabetes mellitus later in life. Metformin use does not guarantee that they will never develop diabetes. The Diabetes Prevention Trial has shown that metformin is no better than lifestyle change (diet, exercise) in preventing diabetes. Controlling our weight with a healthy diet and remaining physically active is the best protection against chronic metabolic illness, including diabetes. 

Can low vitamin D worsen my diabetes?

Vitamin D is a potent anti-inflammatory factor, besides its  protective effects on the insulin-producing cells of the pancreas, its importance in calcium absorption and bone growth and its nourishing effects on the gut microbiome. 

Diabetes mellitus features inflammation as the process through which it damages the organism. Low vitamin D levels leave us vulnerable to the complications of diabetes mellitus, namely blood vessel and nerve damage. 

One of the first steps in diabetes management should be to correct vitamin D deficiency. 

What is the difference between type 1 and type 2 diabetes?

Diabetes mellitus is a condition characterized by high blood glucose levels. There are various forms of diabetes relating to the cause of the problem. Two major categories identified are known as type 1 and type 2 diabetes.

In type 1 diabetes the insulin-producing cells of the pancreas have been destroyed or are non-functional. These individuals do not make enough insulin to survive and rely on insulin injections for life. 

In type 2 diabetes the body is not responding well to the insulin produced and therefore glucose does not get properly absorbed by the cells in the body. We can use pills and/or insulin to improve blood glucose control for patients with type 2 diabetes..

Type 2 diabetes in its origin relates very much to lifestyle and heredity. 

Many factors, including the body's own antibodies may be responsible for beta cell destruction in type 1 diabetes. The role of heredity in the origins of type 1 diabetes is less clear. 

Don't Skip Breakfast

I regularly emphasize the importance of proper timing of meals in controlling weight, blood glucose and cholesterol levels among other health benefits. 

The maxim: 'Eat breakfast like a king, lunch like a prince and dinner like a pauper.'  acquires increased relevance in our modern society afflicted by the scourge of chronic degenerative illness we have come to label 'the metabolic syndrome'.

I published on the application of chrononutrition principles to diabetes mellitus management in 2018: 
Diabetes Spectrum 2018 Jul; ds180014.  https://doi.org/10.2337/ds18-0014

I recently viewed a very interesting video supportive of this message published by Dr. Michael Greger in his Nutrition Facts video series. You will find his message highly informatve. 
https://nutritionfacts.org/video/how-circadian-rhythms-affect-blood-sugar-levels/

With increasing awareness of the importance of meal timing in our health, the metabolic syndrome may soon be known as 'The Circadian Syndrome'.

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J Intern Med. 2019 Aug;286(2):181-191. doi: 10.1111/joim.12924. Epub 2019 Jun 10.