Dr. Richard A. Guthrie, M.D.

There are many reasons for weight gain or loss & without more information about you, I can't really answer your question specifically. What kind of diet are you using? How much exercise do you do? Daily, weekly, etc.? In general wt. gain or loss follows the Newtonian laws of physics i.e. Matter & energy are neither gained or lost in the universe. They are just changed from one form into another. In keeping with this: If we take in by mouth more matter (that's called food) than we burn for energy then we store the excess as another form of matter (that's called Fat). To get rid of the fat we must burn more energy &/or take in less matter preferably both. The number though are difficult to understand. An hour on an exercise bike without added friction & at moderate speed burns only about 80 calories. You can replace this several times over with a glass of juice, a sandwich or OMG a doughnut after the exercise & you will have gained more than you have lost. There are other problems associated with wt. gain or loss. See a physician to be sure you do not have another problem (hypothyroid, Cushings disease, etc.), then see a good dietician and an exercise physiologist to outline a program for you based on you age, physical limitations, etc. One on the best & cheapest places to get a good program of this kind is the YMCA. So, if you have access to one see them & they can be of help at a reasonable price. Avoid FADE diets & fake simple remedies advertised in the newspapers. They make it sound so easy (just take our MIRICLE DRUG and fat disappears like magic). These are a scam selling you herbs you can grow in your garden at a grossly inflated price. These companies disappear when the FDA gets on them, but they go across the street, change the name on the label and continue the scam. Don't fall for it. Don't even send for their free samples. Once they get your address they will continue to send the worthless drugs with a bill & it is all most impossible to stop. Don't get caught. Use only certified programs with trained people.

Good luck!

This question came to me probably after the surgery. The surgeon & anesthesiologist should be aware of your diabetes and your treatment program. Consultation with your physician or a diabetes specialist would be advisable. Control of blood sugar before, during & after surgery is needed to get the best healing with fewer complications such as wound healing, blood clots, infection, etc. So, the program to be used should be planned before the surgery with appropriate consultants. How it is done depends on what type of surgery you are to have, how well your diabetes was controlled before surgery, what type of diabetes do you have and how is it being managed (what medicines), etc. The problem of keeping you in good control without hypoglycemia may be simple or complex depending on the combination of factors above. I hope it all turned out well for you.

Could be, but I doubt it. Diabetic neuropathy usually begin at the farthest point from the central nervous system, i.e., the feet. The initial symptom is usually a burning or "pins & needles" in the feet, especially at night. My suspicion is that this is more likely a blockage of arteries in the legs, but I really can't tell with the brief description you provided. Take her to a physician (one that specializes in peripheral artery disease or a neurologist). They have instruments that can measure nerve and blood flow & tell the cause. Do this soon since if arteries are blocked or even partially blocked, gangrene of the toes or foot can occur. Both the causes I mentioned (and there are other causes such as vitamin B12 & others) are treatable so get her to the Dr. right away & find out the cause & get it treated.

To answer this I would need to know what diabetes medicines & what BP meds you are taking. For most of the meds, it doesn't matter. I take insulin when I eat and a long acting insulin at bedtime. I take my BP meds also at bedtime when I brush my teeth. It seems to work well that way. I am taking 3 BP meds, an ARB, a beta blocker & a calcium blocker & there seems to be no interaction. My A1c is 5.8% & my BP at last Dr. visit was 130/60 so it seems to work to take the bedtime insulin & the BP meds together. Some oral agents may be a problem with BP meds but I can't advise you further without knowledge of what you are taking.

If this is a cystic structure, it is probably not a problem. Non the less it would be a good idea to get it checked further. I would get a Free T4 & TSH level and an ultrasound of the thyroid to be sure it is cystic & if there are other cysts &/or any solid masses. Most cysts are benign & need no RX but you need to be sure that is what it is. An ultrasound is a lot cheaper than the MRI & for the thyroid may be better. See an endocrinologist & if you can one that specializes in thyroid disease.

There are several meds you could take though the one you are taking is one of the best. If it is not controlling your hypoglycemia, the dose can be increased. I have used doses of 100 to 150 mg of diazoxide in some of my patients. There are also several other meds such as somatastatins but at your age I would be reluctant to use them since they not only block insulin secretin but also block growth hormone & would stunt your growth. First though I would like to know what is causing the hypoglycemia. It can be due to a pancreatic tumor which can be removed & thus cured or a host of other causes such as a failure of glucagon secretion, nesidioblastosis, liver disease, etc. See a physician up to date & find the cause. It may be curable without meds. Also watch your potassium levels on diazoxide as it can be low. Phil., Pa. has a good clinic for this. If you are not too far away you might consult them.

No I would not. Acupuncture may be effective for some things such as pain but it will have no effect on a thyroid problem. Hyperthyroid is a dangerous disease as it can cause severe wt. loss, heart failure & death. Don't mess around with pseudo-cures. There are 3 ways to take care of it-medication, surgery & radioactive iodine. I recommend the latter. It is so much easier than the other 2. Just drink some liquid or take a pill of radioactive iodine & it's over. BUT DO IT-it could save your life.

Yes it can but not always. Type 2 diabetes is a genetic disease and with both parents having the disease (I presume they have Type 2), you are at very high risk. The mental aspects of Yoga will help your mental & spiritual development but will not prevent diabetes. Even though diabetes is a genetic disease, there are environmental factors mainly weight. So keep your weight down, eat right and exercise. Yoga will help with the exercise part. Good luck.

Having nighttime low BS suggests you are taking insulin. Not knowing what kind of insulin you are taking, I can't really give more than general information. If you are taking NPH insulin at supper or at bed time, then change to Lantus or Levemir or one of the new long acting insulins. If you are taking Lantus or Levemir, then change to an ultra long-acting insulin (Treshiba or Tuojao). There is less danger of hypoglycemia with these ultra long-acting insulins. They are expensive, but the companies are providing pharmacy cards that greatly reduce the cost. Indeed, Sanofi company provides free insulin for awhile. Talk to your Doctor about this and fix it.

There is no answer to this question. Everybody is different. How long depends on your diet, weight, exercise, degree of lose of insulin producing ability so far and most important your compliance with the diabetes regimen your Dr. puts you on. In any event I would not try to go it alone without medications. Metformin is very cheap and effective and safe. I would take this medication even if I'm doing well without meds since we now have data to say the metformin may not only help diabetes but may also prevent some types of cancer & maybe slow or prevent Mental deterioration that comes with age.

There are three forms of treatment for hyperthyroidism. Medication, surgery and radio-active iodine. My preference is nuclear radiation with the iodine. It is simple and relatively free of complications. Surgery has dangers such as cutting the recurrant laryngeal nerve effecting speech and removing the parathyroid glands with then problems of calcium control. Medication requires long term taking of pills with no stopping date known. Meds can also cause liver damage and reduce the white blood cells making you more susceptible to infections especially thrush of the mouth. RAI is virtually free of problems & is simple to do. With all the treatments, there is a greater than 90% chance you will need to take thyroid meds for the rest of your life but thats easy-1 tiny pill/d. Most important if you have this problem get it fixed as it is damaging to the heart.

YES!! There is hard data that high blood sugar causes eye damage, kidney damage, and nerve damage (microvascular disease). The data for large vessel damage (heart disease & stroke) is less sure, but are accumulating that high blood sugar does affect the blood vessels of the heart & brain. So, keep your BS in control & don't tempt fate!

Yes diabetes can be managed without insulin. People with Type 1 diabetes cannot be managed without insulin. For them stopping insulin signs their death warrant. It has been tried many times with the same results since they have no or very little ability to produce insulin internally. For Type2 diabetes: Yes you may get bye for a long time without insulin. Initial treatment for T2D is Diet, exercise and usually metformin ( cheap pill you take once or twice a day-no big deal). If this does not maintain control the other oral or injectable meds can be added. If you follow diet, lose weight, exercise and take metformin and /or other oral meds you may not need insulin for many years. Please don't fear insulin though as the new insulins are safer than the old insulins (though not cheaper!) and are given now with disposable syringes with very tiny needles that are nearly painless. So don't fear meds or even insulin but good luck with the diet & exercise. Most important-KEEP THE BLOOD SUGARS UNDER CONTROL to prevent complications of the disease.

A clot in the leg is very important. It may be partially related to diabetes since diabetes can cause "thickening" of the blood, especially if poorly controlled. But clots can occur in anyone, especially after an injury. In any event, GET TO A DOCTOR! Clots can break loose & go to the lungs with serious consequences, even death. She needs to be on an anticoagulant & under careful observation by a physician.

This is curious since we have been taught that BS decreases after exercise. I suspect what is happening is that with exercise your liver is putting out insulin in response to stimulation from adrenaline or other hormones. This would raise the blood sugar temporarily to insure that there is enough sugar for the brain. Take a snack before exercise & see if this will ease it by keeping enough sugar in the system & not trigger the counter-regulatory hormones.

Get under the care of a competent kidney specialist. She will probably need diuretics, if not now on them, & perhaps dialysis. You did not tell me how bad her kidney disease is and whether she is on medication or dialysis, so I cannot precisely answer your question except to say get under the care of a good nephrologist if not already there & follow his or her instructions.

The surgeon will probably be giving IV fluids containing glucose to maintain her blood sugar until she is ready to eat. How soon that will be depends on many factors such as what medicine she is on, what kind of anesthesia they use, how long the procedure lasts, etc. so I can't tell you a definitive answer. The physician or nurse can judge this as you go along. Be sure they know so has diabetes & the medicine she is on so the can observe her blood sugar & give proper treatment.

No surgery will not help if your neuropathy is due to diabetes. This is caused by damage or even death of nerves by high BS. If mild or early it can be reversed by improved control. If the nerve is dead, it cannot be reversed so careful observation of the feet is needed to prevent ulcers. There are medications that can help the pain & burning. See your Dr. and get a medication & get & keep your BS in control.

YES it can. An overactive thyroid (hyperthyroidism) stimulates the heart to beat harder & faster. This can lead to congestive heart failure & even death. If you have this see a Dr immediately and get it taken care of as this is curable with medication, surgery or radioactive iodine.

Depending on the inflammation and the degree of risk of heart disease, steroids may or may not be safe. If the inflammation is severe & the heart risk small then steroids if properly used should be safe. If the reverse is true then be very careful. Steroids will raise blood sugar & cause fluid retention so consider the benefit ratio with your Dr.