Dr. Richard A. Guthrie, M.D.

It depends on the level of control of her diabetes. If she is well controlled, there is little difference than if she did not have diabetes. But if she is not well controlled now, the surgery should be postponed until she can be gotten in good control. For surgery of this type, she will most probably need to be taking insulin preferably "basal-bolus" therapy to insure the best control. She should have an endocrinologist that is knowledgeable in diabetes therapy to work with the surgeon to provide maximal care. Then expect a good outcome.

It would certainly be wise to have a check with a cardiologist. Cardiac disease is a significant risk in diabetes so frequent cardiac checks are a good idea. So YES it is time to see the cardiologist & get a good checkup.

This is a very good question for which there is no easy answer. Ideally, you would want to be under the care of an endocrinologist who is well trained in diabetes (not all endos are). The problem is there are not enough endos. Endo is the lowest paid specialty in medicine so not many people want to go into it. So as the prevalence of diabetes goes up the available endos. goes down. So, your best alternative is a good internist who has kept up with the developments in diabetes therapy. These may also be hard to find but try. FP's are ok but many are so busy they don't have time to keep up on the latest research. Ironically some of the best "diabetologists" are nurses. Certified Diabetes Educators, especially those with advanced training as Advanced Nurse Practice nurses are quite good & most have more time than the DR. to keep up on the fast changing world of diabetes. I hope you find someone good & keep your diabetes in good control.

Yes, it can adversely affect the fetus so it must be treated. Surgery has been shown to have a higher spontaneous abortion rate than medical Rx. Medical treatment can be with radioactive iodine or anti-thyroid medications. There is a danger with RI that some of the radiation can effect the baby so it is nor recommended. (I did have a patient who was given RI by another DR. during a pregnancy with diabetes & hyperthyroid. There was no damage to the baby.) I would recommend treatment with an anti-thyroid drug as safest. These drugs can cross the placenta & enter the fetus thus blocking their thyroid. The baby's Dr. then must know of the treatment so the baby can be treated with thyroid until the gland recovers from the blockage (usually a few months).

There are now a number of drugs to help you control your hunger. Talk to your Dr. about the proper choice of drugs. It hard for me to advise you because you did not tell me what you are taking now. Probably one of the best drugs for depressing appetite is a drug from the class of drugs called GLP1 RA. There are now many drugs available in this class. You have probably seen them advertised on TV. Some of these drugs have to be taken daily (Victoza) but several (Trulicity, Ozemka, etc.) are once a week. They are working on a once a month one. They must be taken by injection. I take one of them & the injection is painless. I have lost 25# & decreased my insulin by 25% with this drug. They are working on an oral form of these drugs. There are at least 4 other drugs that can help as well. So see your physician to go over what drug or drugs would be best for you.

YES, you could have diabetes. Here are some of the symptoms 1) Polyphagia- excess hunger yet with weight loss 2) polydipsia- increased thirst 3) polyuria- increased urination. When you started the description of your problem, you presented symptoms of an insulin-producing tumor, then the description seemed more like diabetes. PLEASE see your DR. right away. He can determine the cause of the problem usually from office tests. If you have an insulin-producing tumor, there are medicines that can treat this or surgery can remove the tumor. If it is diabetes, it needs treatment right away. There are many treatments for diabetes and it can be controlled. To put off getting treatment can cause many complications or even death. So, SEE A DR. RIGHT AWAY.

There are many reasons this could be occurring. Assuming she has diabetes & is on a diabetes medication, then the type & dose of the medicine should be adjusted. As we get older, we tend to eat less & thus need less medication to control blood sugar. If she does not have diabetes, there are multiple possibilities. Intake of carbohydrate may be too low, there can be abnormalities of the liver that is not controlling carbohydrate right, there may be a pancreatic tumor (usually not malignant) producing too much insulin (easily removed), and many more causes. She needs to see a Dr. familiar with the causes of hypoglycemia and get appropriate tests as most of the causes can be treated and thus cured.

Yes it could be. You didn't tell me what diabetes medications you take so I can only answer in general. Some diabetes meds can cause hunger, especially with some combinations. Sulfonyluria drugs as well as insulin can cause continued hunger especially when used together or with other diabetes drugs. So see the Dr & maybe get a change of doses of drugs or a change of drugs. Metformin & GLP1 RA, & SGLT1 drugs do not cause hunger but if used with other drugs such as insulin, they may enhance the effects of the insulin or other drugs & cause prolonged hunger. See your Dr. & discuss to get an adjustment of meds or doses of current meds. Some of this can just be habit as well or type of food so see a dietician. You may be having rapid stomach emptying & in that case Rx with a GLP1 RA would be helpful since these drugs slow stomach emptying and slow hunger. These drugs are injections but can be given once a day or now several are available for once a week. They do work. I take one of the once a week drugs & it really works. I have lost 25# in 3 mo., don't feel hungry as much, & reduced my insulin 30%. Suggest it to your Dr.

That is a difficult question. Some people with T2DM never need insulin and some need it very early in the course of their disease. It depends on the severity of the damage to the insulin producing cells of the pancreas. If they have been badly effected by whatever causes the disease (genetics, overweight, insulin resistance, factors we don't yet know, etc.) then we may start insulin soon. Most people with T2DM have some residual insulin producing ability so may stay on oral agents for a long time. Multiple oral agents at once & a variety of agents (there are about 20 now) should be tried along with diet, exercise & wt. loss (life style change). Check blood sugars regularly along with A1c and adjust meds. When a combination of 2 or 3 oral meds will not control the BS & A1c then is the time to start insulin injections. If only the fasting BS is up then we continue the oral agents and start a once a day long acting or basal insulin to control things during the night. If then BS after meals is found to be up we would add insulin at mealtimes while continuing the basal insulin. Some of the oral agent may then be stopped but we like to continue metformin for some effects perhaps unrelated to diabetes. We might also continue or start a GLP1 RA injection as this will help the insulin and may help weight loss. There is some evidence that it may halt or slow death of the insulin producing cells & may even cause some regeneration of these cells. The above are not proven yet but some animal data are hopeful. By the way, a need to go to insulin does not mean you have done anything wrong. Degeneration of the cells is a part of aging that diabetes accelerates. But you should follow good health practices to prevent insulin resistance & keep a load off the cells to help preserve them.
Good luck!

Metformin affects the body, but I suppose you mean "does long-term metformin adversely affect the body." The answer to that question is probably no. We have been using metformin in this country for 30 years & in Europe for over 50 years with few adverse effects. Thousands of people have been treated with it for many years safely. The only bad effects are the gastrointestinal effects usually seen for a few weeks at the beginning of therapy then go away and a condition called "lactic acidosis" if given with kidney disease. I have treated thousands of people, many of them for many years, & have seen only 1 case of lactic acidosis. This occurred in a man with kidney failure who should never have been taking metformin. Metformin is not only safe for many years, but some recent data have shown some long-term effects that may be beneficial apart from its effect on blood sugar. There are some preliminary data to suggest that metformin may change gut bacteria for the better helping with some inflammatory diseases. It may also prevent certain cancers such as breast & prostate and some very preliminary data suggests it may slow the development or progression of Alzheimer's disease. These are all preliminary data mainly in animals, but they are certainly exciting. So don't be afraid of long-term metformin. If it is working, keep it going. It is certainly the cheapest med you can take for your diabetes. Above all, take whatever you need to keep your blood sugar & A1c in control. Metformin can be taken with other diabetes meds & may help them so GO FOR IT!

Hashimoto's thyroiditis is a common problem though more common in females than males. It is a auto-immune disease in which the immune system develops an error and attacks it's own tissue, destroying it. This may result in a goiter as the failure of the gland stimulates the pituitary gland in the brain to stimulate the failing thyroid gland causing it to enlarge. Ultimately the gland fails completely in spite of overstimulation of the pituitary gland & symptoms of low thyroid activity results. The treatment is relatively simple: Oral thyroid pills in a proper dose as determined by a physician with proper lab. tests of the blood thyroid level as well as the level of pituitary stimulating hormone. Adjust the dose of thyroid medication until the levels of both hormones are in the normal range & monitor frequently to be sure the need to change the thyroid dose hasn't changed (or adjust the dose if it has). Thyroid hormone, known as thyroxine, comes in a small pill and comes in a large variety of doses (many people of different sizes and ages including infants may need thyroid) & each dose has a different color. The color coding is the same even if the thyroid is made by different companies. Generic thyroxine is ok & is cheap. Treatment can make a big difference in things like energy level, etc but more important, low thyroid can result in heart damage & congestive heart failure. So keep the thyroid in proper control with a pill a day-but be sure it is the right pill.

Eye checks are very important in people with diabetes. If you have no eye problems at present and your diabetes is well controlled then an eye check once a year is recommended. If any diabetes problems or problems of the eye unrelated to diabetes then more frequent eye checks are needed. Follow the advise of your eye doctor in this regard. Above all keep your diabetes in good control as this will help prevent diabetic problems of the eye. I have had Type 1 diabetes for 26 years, along with hypertension for 50 years, but have no diabetic changes in my eyes. So it can be done though it is not easy. So keep the diabetes in control and get an eye check at least every year.

This answer is easy: eat less & exercise more! I'm sorry for being flippant about this, but in fact it is true. Avoid fad diets as they are nothing more than a reminder to consume less calories (and make money for the purveyor). Wt. gain or loss follows Newton's law of thermodynamics & we all remember that, right! What he said was that matter & energy were neither created nor lost in the universe. They are just changed from one form into another. So if we take in more matter (food) by mouth than we burn (normal activities & exercise) we store the consumed matter as another for of matter (that's called FAT). If we want to get rid of the stored matter we must do one of 2 things (or preferable both) consume less matter &/or burn more matter for energy (exercise). It is that simple & yet that hard. There are aids you can use under a physicians guidance. There are now appetite suppressants, food absorption blockers, & gastric emptying retardants. You didn't say if you have diabetes but if you do a good treatment for the diabetes is a group of drugs called GLP1 RA. You have seen them advertised on TV-Victoza and many that you take once a week such as Ozempic which I take. It allowed me to reduce my insulin by 30% with good control and I have lost 25# in 3 months. YEA! & there are several short acting (2-4X/D), intermediate acting (one injection daily) and the long acting (one injection weekly). Check with your physician to see if any of the above mentioned medications would be right for you.
Good Luck!

There are good & bad ways to clean your feet. Check with the American Diabetes Association (a local office or national) AS they have a lot of articles on foot care. In general terms, inspect your feet every day for any abnormalities. If you can't see the soles us a mirror on a stick (the sticks used for "selfies" with a phone camera works well. You can even use the camera & take a picture of the soles of your feet & be able to study the pictures to look for any problems. To clean the feet use warm, not hot water, and wash with a mild soap and water. Clean well but don't scrub hard. You can also soak the feet in warm water but not too long as they will get dehydrated & "pucker". If there are dead skin accumulations on the feet an emery board & mild use will remove. Don't be too vigorous & damage good skin. Other chemicals suck as Epson Salt soaks are not needed. Plain warm water with a mild face soap will do well. Just inspect often & keep clean & soft & report any discomfort or lesions to your Dr or Podiatrist right away. Enjoy the soaks

Yes & no. Now that's a worthless answer, but it is true. If your diabetes is well-controlled, then the healing process should be no different than if you did not have diabetes, so the answer would be no. Your ankle should heal as if you did not have diabetes. If your blood sugar is NOT well-controlled, the answer is different. Poorly controlled diabetes (high blood sugars & an elevated HbA1c) will impair healing & may allow wound infection & poor healing. So, get your blood sugar under control and your HbA1c below 7% (ideally below 6.5%) before surgery to get the best result. Also, get a consult with a diabetes specialist to assist your surgeon & you in the post-op management to get the optimum results. It can be done with good results, but it takes some work on the part of the medical-surgical team and YOU.
I hope for you a good result.

He could, but he doesn't have to. Many studies have now shown that eye & kidney disease in diabetes is caused by elevated blood sugar levels that cause damage to blood vessels & nerves. These complications are not only preventable, but are reversible if caught early & properly treated. Control of blood glucose is most important in the prevention of these problems, so keep his sugar in control preferably without hypoglycemia. It can be done, so be open to new therapies including pumps & continuous glucose monitors to help.
All the best!

Yes you should. We have made progress in preventing foot ulcers and amputations in persons with diabetes but we're not through yet until we prevent all loss of toes, feet or limbs due to diabetes. SO 1) Keep your diabetes in control & A1c down as high blood sugar damages the blood vessels and nerves of the feet & causes burning pain, loss of sensation & positional control, foot ulcers, infection & amputation. 2) inspect your feet daily. If you can't see them then have someone look or attach a mirror to a stick or pole {a cell phone on a selfie stick will work} and view at least daily 3) if any abnormality is found see a Dr. & that can be a podiatrist. 4) see a podiatrist on a regular basis or be sure your physician inspects your feet at every visit. Let's prevent all foot ulcers & amputations and put those surgeons out of business!!

There are many options now to treat diabetes and many of the meds can be used in combination so the options of many therapies are many, but following certain rules of life (diet, exercise, smoking cessation, limited use of alcohol, checking blood sugar levels several times a day, etc. are necessary on your part to be successful). If your regular physician cannot get your sugar under control then go to a clinic where there is a team approach including knowledgeable physicians, diabetes trained nurse specialists, dietitians, councilors, etc to help you. It can be done. When all else fails insulin always works if you & your physician know what ones to use & how to use them. There is basal-bolus insulin therapy, insulin pumps, continuous glucose monitoring, etc that can achieve control in anyone who is willing to work at it, It's not easy but it can be done. I have had Type 1 diabetes for 26 years. I use on insulin pump and a Libre monitor. My last A1c was 5.8% SO IT CAN BE DONE. It is not easy & I hate having the disease, but I have learned to live with it and control it & so can you.

Please see a urologist soon. This condition is common in people with long standing diabetes but it is treatable. Urinary incontinence is common in all people whether they have diabetes or not (see how many commercials for adult diapers there are) but it especially a problem in some people with diabetes. Here it is caused by deadening of the nerves to the bladder so it cannot empty completely & thus carries a residual with overflow. There are treatments for this and seeing a urologist who specializes in this is important. If the nerves are not completely dead, the condition can be reversed & the nerves regenerated by improved blood sugar control. Work on it & get help with a good urologist.

The answer to this is a big YES. People with diabetes are at greater risk of heart attack & stroke that those without diabetes. Whether we can prevent these complications by improved diabetes control is a strong debate in the diabetes world. Some studies say yes & some are equiv. I am a believer that "God or nature" set parameters for the blood glucose levels we should live at. If we are unlucky enough to have diabetes, we should still live within these parameters. A low blood sugar will affect our brains since it can function only on sugar. Too high a blood sugar causes damage to the blood vessels & nerves of the body and the long term complications-blindness, kidney failure, foot ulcer & amputations, heart damage & stroke, etc. SO keep your blood sugar levels in the proper range. Get a good diabetes education from a licensed diabetes educator, follow the guidelines given for life style, keep your A1c below 7% & preferably below 6.5% ( it can be done mine is 5.8% after 26 years of diabetes). It isn't easy & I despise this disease but I have to live with it as we all do who are unlucky enough to have it, so we must accept it and do the best we can to control it & not let it control us. GOOD LUCK!