Dr. Nicholas H. E. Mezitis, M.D.

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.

Nicholas H.E. Mezitis, MD, PhD

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.

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.

The body has difficulty properly digesting nutrients late in the day and glucose levels will be higher than desirable after the meal. Glucose levels significantly above range (usually over 200 mg/dL) may be associated with neurological symptoms such as numbness, tingling or pain in the limbs. Carbohydrate-rich meals (pasta, potatoes) can also cause sleepiness. I recommend that patients focus on having their largest meal at breakfast with a generous lunch and a light supper. My book
A Blueprint for Healthy Eating: Your Diet Guide for the New Millennium
available at www.mer-llc.com or on Amazon explains why eating major meals between 4 AM and 4 PM improves diabetes and controls weight.

Your description of symptoms suggests thyroid inflammation. You should check to see the names of the antibodies reported on your tests. TPO and antithyroglobulin antibodies are seen in thyroiditis. Rheumatoid arthritis features antibodies as well (ANA, RA) and is frequently associated with thyroiditis. You have been prescribed a thyroid supplement, which means you have already been diagnosed with hypothyroidism. Painful thyroiditis, however, may require short-term treatment with anti-inflammatory medications, including steroids for relief. Treatment for rheumatoid arthritis, if present, involves long-term management with anti-inflammatory medications.

Insulin an be safely stored in the refrigerator until its expiration date if unopened. Once used you may keep the vials or pens at room temperature or in the refrigerator for up to 30 days. For insulin taken from the refrigerator for use, briefly rubbing the insulin vial or pen between the palms warms up the liquid and ensures proper mixing for injection. 'Long-acting' insulin will appear uniformly cloudy when ready to inject.

Checking for hypothyroidism involves a simple blood test known as TSH that your primary care physician can order. This can be performed at a testing center near your home. Results are usually available the same day. Stomach issues, weight loss and fatigue can have other causes, which frequently relate to depression. This possibility should be explored in your case and will require a visit to your physician. Keep in mind that telephone/video visits are now possible and are covered by insurance.

Pain in the hands in diabetes may reflect sensory nerve damage (neuropathy), stiffening of tissues (finger triggering), or carpal tunnel syndrome from pressure on the median nerve at the wrist. Sensory neuropathy is frequently seen in poorly controlled diabetes and affects both hands in glove distribution with pain or burning experienced throughout the day, but worse at night. Carpal tunnel syndrome can cause numbness and tingling in selected fingers, but can also affect the whole hand and weaken the grip over time. Arthritic pains are a possibility, but they usually are a chronic complaint reflecting wear and tear of finger joints over years.

A glucose meter is a good first step in increasing awareness about the importance of proper meals and mealtimes. It is important to use a control solution provided for your meter to check its calibration and reliability. The most important time to check the blood glucose is before breakfast. A result less than 100 mg/dL is optimal. Achieving these scores is feasible , if late dinners are avoided. Check my book A Blueprint for Healthy Eating: Your Diet Guide for the New Millennium (2nd edition) available at www.mer-llc.com or through Amazon for details on the importance of eating major meals between 4 AM and 4 PM to control blood glucose and avoid weight gain.

Type 2 diabetes indicates that the body is making insulin, but the insulin produced is not sufficient in overcoming resistance to its action. This requires using pills and/or insulin to control blood glucose levels. Monitoring blood glucose with fingerstick testing is important in order to understand how to control diabetes with medications, diet and exercise and to avoid low blood glucose reactions. Confusion, weakness, stiffness and even seizures and unconsciousness can result from a low blood glucose experience. In order to be sure that a low blood glucose has caused the stiffness we should check the blood glucose during the episode and we would expect rapid recovery with juice or a glucose snack.

Type 2 diabetes is usually one of the features of metabolic syndrome, which includes abdominal obesity, high blood pressure and high cholesterol. High uric acid that leads to gout is also a feature and is frequently neglected in management. Your symptoms suggest this problem. However, infection is always a danger must also be excluded. A visit to a physician for blood work and treatment is important and should not be delayed.

Insulin is available in inhaled form (Afrezza) in the United States. Oral insulin spray is available, but has not been approved in the United States. Oral insulin in capsule form and intranasal insulin are being investigated for marketing. Dosing these products is not as flexible or as reliable as insulin injections and may influence our choices in many situations. The convenience and minimal discomfort of pen injection devices currently in use for insulin delivery has made them the preferred mode of treatment for patients requiring insulin who are not using insulin pumps.

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.

Nicholas H.E. Mezitis, MD, PhD

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.

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.

Several events take place in the body after a meal which may cause the individual to feel tired and sleepy. Here are some examples:
First, blood supply to the gut increases preferentially, leading to redistribution favoring the central nervous system less and causing the individual to seek rest.
Second, the balance in the autonomic nervous system that services the gut shifts to favor the parasympathetic system that relates to a low energy state and a desire to limit activity
Third, foods rich in simple carbohydrates (sugar) generate an insulin response that shifts amino acid concentration in the blood and causes tryptophan to be taken up by the brain. Tryptophan is converted to chemicals that cause sleepiness (serotonin, melatonin).
Fourth, increased insulin moves potassium from the blood stream into cells. Lower circulating potassium levels can contribute to fatigue.

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.

Seasonal fruits which are available in your region are the best choice. I recommend a cup of fresh fruit as part of a mixed meal which includes protein, fat and vegetables. Please refer to my book 'A Blueprint for Healthy Eating: Your Diet Guide for the New Millennium' 2nd edition (Amazon) for details.

Gestational diabetes remains a risk factor for developing diabetes mellitus later in life, even when blood glucose levels return to normal after delivery. The key is prevention, which involves avoiding significant weight gain, observing diet rules for balanced meals and being consistent in a program of physical activity.

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.