Health Topics

Listener Questions

Andrew Schorr:

Right, I’ve read that and know people with that. Let me fire some questions to you that we’ve gotten from some of the people in the area. Gail from Bellevue, Washington, so right really where your clinic is, wrote in and said, ‘I find that every time I eat something sweet I have blurred vision and pain in the top of my head and eyes. Could this be a symptom of diabetes? I’ve never been diagnosed.’

Dr. Choudhury:

Yes. High blood glucose can sometimes cause blurry vision. So if you are definitely seeing a correlation with high glucose intake and blurry vision you should be checked out. You should see a doctor and get a blood glucose test.

Andrew Schorr:

All right, here’s a question we got from Nancy in Kent, Washington. She says, ‘I am diabetic and have been having horrible neuropathic pain in my feet. What can I do about this, and could physical therapy help?’

Dr. Choudhury:

I don’t think physical therapy would help with neuropathy. If she has been appropriately diagnosed by her physician with neuropathy then the thing that is very important is glucose control. If you control your glucose very, very intensely you have a really good chance of reversing that neuropathy if it hasn’t been present for too long. If you have long-term neuropathy you can still prevent it from getting worse by controlling glucose. If one has a lot of pain and symptoms from the neuropathy there are certain medications that one can use to control these symptoms.

Andrew Schorr:

All right, and one final question from Meredith in Seattle. Now she is on insulin. She said, ‘I’ve been a type 2 diabetic for more than 14 years, and I now take 18 units of Lantus at night and 1 unit of NovoLog for each meal as well as 1,000 mg of a Glucophage pill at dinner.’ She says her readings are great averaging about 130, but she experiences lows and has no energy and can’t think clearly. She says, ‘Not a good thing when I’m working and driving. Could I be getting too much insulin?’ she wonders.

Dr. Choudhury:

Yes definitely she might be getting too much insulin if she’s having frequent low blood glucose reactions. I think it’s very important for her to discuss this with her provider and come up with another plan to prevent low blood glucose.

It’s important to check your glucose frequently and adjust the insulin whether it is Lantus or any of the other insulins frequently. A lot of diabetics do use what we call fixed-dose insulin, and they don’t really check their blood glucose. I think that can be very dangerous. One does need to check their glucose and adjust their insulin frequently. So if she’s having low blood glucose reactions it’s time for her to go back to her doctor and talk about this and in the meantime start checking the glucose 3-4 times a day and make a log so that will be helpful for her doctor to adjust the insulin.

Andrew Schorr:

Dr. Choudhury, Rick brought up this term “prediabetes” when he was talking about Carol his wife. What is prediabetes, how would it be recognized, and is there anything we can do about it?

Dr. Choudhury:

Prediabetes is something that we are sort of going away from defining specifically. It’s either diabetes or not diabetes, but one can have risks for developing diabetes, and I think that’s what Rick is indicating is that probably his wife has many risks for developing diabetes such as obesity, high cholesterol, high blood pressure, poor diet, and also family history sometimes may also increase your risk for developing diabetes.

We do perform blood tests in people who have risk factors for diabetes, so if anyone has risk factors, the ones that I mentioned; being overweight, having a family history, and sometimes having symptoms such as Rick had when he was diagnosed such as going to the bathroom more frequently, being thirsty and more hungry; then one can get some blood tests done.

Prediabetics are those that do not absolutely have very high blood glucose and other blood tests that indicate they have actually diabetes, but they do have all these risk factors that may eventually make them develop diabetes. So if one has any kind of risk factors but does not have absolutely positive tests diagnosing diabetes then they have to be monitored closely, and lifestyle modification is very important.

Andrew Schorr:

All right, let’s just recap some things for really we’re talking about millions of people who need to hear this. So first of all from the way you describe diabetes if you can avoid it you want to. It is not a good health condition, although unfortunately there are millions of people living with it. If you do get diagnosed with diabetes you want to control it, and the number one person responsible is yourself, right?

Dr. Choudhury:

Yes, I agree.

Andrew Schorr:

Okay, so diet, exercise, monitoring, working with a knowledgeable healthcare provider such as yourself, and that ongoing; it’s a change for life, right?

Dr. Choudhury:

Yes, absolutely.

Andrew Schorr:

All right, and that can make a tremendous difference even being able to reduce or sometimes even eliminate medications?

Dr. Choudhury:

Yes definitely. One may be able to eliminate medications in situations where they have lost weight and they have changed their lifestyle significantly. They may be able to go off medications sometimes, yes.

Andrew Schorr:

I told Rick on the phone before we started the program that I was going to let him get on his soapbox a little bit. I wanted to give him a chance. Rick, you went 10 years kind of bumping along, you know, putting on weight, doing less exercise, really pouring yourself into your work, moving, changing locations around the country, and yet your diabetes was progressing really, and you made a big change that I know you feel great about. There are people listening who have not done that yet or maybe it hasn’t really hit them how important it is. What do you want to say to them?

Rick:

What I want to say there is definitely work very closely with your doctor and listen to their recommendations and work at it. To do this, not just the medications, you’ve got to change your lifestyle, and that’s not diet because we all go on and off of diets, but you’ve got to change what you eat so you need to become a subject matter expert on nutrition. Get away from processed food and get back to some of the natural food. You’ve really got to cut sugars out. You’ve got to lower carbs for the most part. Watch your protein to protect your muscles, and watch and see what nutrients you need to take but definitely get exercise.

Now I hate to run, but I love to ride a bicycle, so here in Washington I’ll get out in the warm weather and ride 10, 15, or 20 miles, and I’ll drop blood sugar points that day 20 points. In the winter time when it’s rainy you can go for a hike out here, and after that you go into the gym and get an exercise bike or hit the weights from that standpoint.

So you’ve got to watch your nutrition, you’ve got to get some exercise, you’ve got to monitor your glucose, and work very closely with your doctor.

Andrew Schorr:

You sound pretty passionate about it now.

Rick:

I am now that I’ve gotten here. I’ve found a solution where I can really reduce my medication and hopefully long-term reduce it to the point where maybe I can get off of it. So I’m very happy that Dr. Choudhury has helped me find that solution.

Andrew Schorr:

Dr. Choudhury, you must just be beaming hearing Rick not just talk about you but about the changes he’s made.

Dr. Choudhury:

Yes, thank you Rick for saying that about me, but I think the most important thing is that Rick has really helped himself. I’m just there to support, but really he has done this himself by lifestyle modification. That is so important. Also one very, very important factor with Rick is that he’s always very regular. He comes in for his check-ups very regularly. He’s keeping on top of everything, not just the diabetes, but blood pressure and cholesterol. That’s so important to get your blood tests done every so often as recommended by your provider not just for diabetes but also the cholesterol, the blood pressure, that’s important too.

I think a lot of patients once they come in and they’re told that they’re diabetic and they’re started on a medication feel like that’s about it, that’s all they need to do is to take that pill, and that’s it, but there are a lot of other things that you can do to improve yourself. There are a lot of diabetics that go on for years with no monitoring, and unfortunately in about 5-10 years of poor control of diabetes and very poor monitoring, they don’t like to come and see the doctor, they don’t want to increase medications, they don’t want to do any lifestyle changes most of the time because they are busy or they don’t have the time, and eventually we see that they’ve developed complications; there is a kidney problem or an eye problem or neuropathy; and it’s basically too late then.