EXPERT
Dr. Richard A. Guthrie, M.D.
Endocrinology-Diabetes
Dr. Richard Guthrie practices Endocrinology in Wichita, KS. Dr. Guthrie specializes in preventing, diagnosing, and treating diseases related to hormone imbalance, and the bodys glands in the endocrine system. Endocrinologists are trained and certified to treat a variety of conditions, including menopause, diabetes, infertility, and thyroid disorders, among many others. Dr. Guthrie examines patients, determines means of testing, diagnoses, and decides the best treatment methods.
64 years
Experience
Dr. Richard A. Guthrie, M.D.
- Mount Hope, 20
- Univ of Mo, Columbia Sch of Med, Columbia Mo
- Accepting new patients
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What's the likelihood of a pancreas transplant?
Pancreas transplants are possible &are being done. There are problems associated with them however. You have to take antirejection drugs which can suppress your immune system & READ MORE
Pancreas transplants are possible &are being done. There are problems associated with them however. You have to take antirejection drugs which can suppress your immune system & allow infections. These drugs can also cause cancer & make you feel bad. The transplants have a definitive life span so may die & another is needed. The main problem with pan. transplants though is supply. The are thousands of people with diabetes who would like or need a transplant but only a couple of thousand pancreases are available for transplant. They must come from cadavers who are healthy (motorcycle riders are a principle supplier) donors & there aren't too many of those so the waiting list is long. There are several places you can get them. The Univ of Minnisota & Wash U in St. Louis are 2 good centers. They can also be done at U of Ks, & Okla. & several other places including Boston. Your Dr. can find the closest place to you. There is some good news about transplants though. Several places are working on a way to take the beta cells of the pan. & encase them in a semi-permial membrane so glucose can get in & insulin can get out but the immune system cannot get in & destroy the beta cells. Pig pancreas is so close to human pancreas that it can be transplanted giving us an unlimited supply. The only problem here is that pig viruses are toxic to humans so a way must be found to eliminate them from the transplant tissue. They are making progress on this so the future is brighter. Good Luck!
Why do children get metabolic syndrome?
Metabolic syndrome (MS) is caused by 2 factors. 1) inheritance of diabetic genes. This of course we cannot change. 2) environmental or life style problems (overwt). This we can READ MORE
Metabolic syndrome (MS) is caused by 2 factors. 1) inheritance of diabetic genes. This of course we cannot change. 2) environmental or life style problems (overwt). This we can & must attack. We used to not see MS in children but times have changed. Now over 30% of children are overweight & MS is increasing rapidly in children. If not treated this can wear out the insulin production & Type2 diabetes is the consequence even in children. I have had a 4 yr. old child in my practice with "full blown" type 2 diabetes after 1-2 yrs of overwt. You must attack the environmental life style problem & get the wt. down. The overwt. problem causes resistance to the action of insulin and the pancreas has to secrete more insulin to keep the blood sugar down. This wears out the pancreas too early & insulin goes down & blood sugar goes up (Type 2 diabetes). So there are several things you can do. 1) he should be taking a drug called metformin that reduces blood sugar & thus takes some of the strain off the pancreas ( it also depresses appetite some). 2) limit his screen time so he can exercise 3) see a dietician & get a good wt. loss or stabilization as he grows, diet plan. 4) start a well controlled exercise plan & make him stick to it. 5) if you the parents are overwt. then all of you need the wt. loss. If you don't do it, he won't. If you have access the YMCA is a good place to do this. It is cheap, they have dieticians & exercise supervisors to help. Please do this to slow or prevent him going on to diabetes. Good Luck!
Is it safe for diabetics to have children?
Yes if you have a good DR. who knows how to manage diabetes during pregnancy. In the past, we didn't have the tools to manage the diabetes well & we discouraged pregnancy (even READ MORE
Yes if you have a good DR. who knows how to manage diabetes during pregnancy. In the past, we didn't have the tools to manage the diabetes well & we discouraged pregnancy (even sterilizing some women). We know better now and have better tools. I have managed many women with Type 1 diabetes through pregnancy with beautiful babies. You need a knowledgeable endo. with experience with diabetic preg. working as a team with an ob. who is trained in diabetes management. With such a team you should do well & have a beautiful baby. Send me a picture! I love to see nice babies from mothers with diabetes. Have fun!
Can a person get diabetes at any age?
YES. We used to call these Adult Onset & Juvenile Diabetes but we have now found that both kinds can occur at any age. In my practice I have had a 4 Yr. old with classic Type 2 READ MORE
YES. We used to call these Adult Onset & Juvenile Diabetes but we have now found that both kinds can occur at any age. In my practice I have had a 4 Yr. old with classic Type 2 diabetes. We changed the names to Type 1 & Type2 because of this age overlap as age is not a factor. My mother & I developed Type 1 diabetes after age 50 & I have many children in my practice with Type 2. Get his wt. down & he will improve. In any event he has a long time to have this disease so keep his blood sugar down & his HbA1c below 7% to prevent later complications.
What is used to test for diabetes?
There are 2 simple tests & more complicated ones such as an oral glucose tolerance test. Start with the simple ones 1) a fasting blood sugar test. This is simple and could be done READ MORE
There are 2 simple tests & more complicated ones such as an oral glucose tolerance test. Start with the simple ones 1) a fasting blood sugar test. This is simple and could be done with a simple finger stick in the Dr. office and is the first thing to do. 2) a HbA1c test. This also can be done with a finger stick in some offices or by venous blood in a commercial lab. It tells you what your average blood sugar has been over the last 3 mo. The oral glucose tolerance test consists of drawing blood fasting then drinking a heavy sugar solution the getting a blood sugar at intervals up to 3 hrs. That's not a lot of fun & is not needed in most people. I haven't done one in the last ten yrs. to diagnose anyone. The fasting blood sugar & Hb1c test should let you know if you have or have not gotten diabetes.
Can weight loss help me get rid of my diabetes?
No & Yes. No because diabetes is an inherited disease & we can't change our genes. Yes because diabetes is precipitated and continued by some environmental factors such as body READ MORE
No & Yes. No because diabetes is an inherited disease & we can't change our genes. Yes because diabetes is precipitated and continued by some environmental factors such as body fat, inactivity, overeating, etc. You can't change your genes but you can change the environmental factors that interact with your genes to both contribute to the development & progression of diabetes. Wt. loss will certainly help & you should be about it if you are overwt. It will improve your diabetes control even if it doesn't "cure". You'll always have the inheritance so always control the things you can control-the environmental factors.
If I have diabetes, do I have to take insulin shots?
Not necessarily. There are 2 kinds of diabetes- Type 1 & Type 2. Either or both of these can occur in any age group. If you have Type 1 the answer is YES you must take insulin READ MORE
Not necessarily. There are 2 kinds of diabetes- Type 1 & Type 2. Either or both of these can occur in any age group. If you have Type 1 the answer is YES you must take insulin injections to stay alive. If you have Type 2 then you may not need insulin injections. There are many oral meds you can take & modifying your life style by proper diet, exercise and wt. lose if you are overwt. will help you to remain in control on oral agents. You must be aware though that with time there is deterioration of the cells that produce insulin in everyone & it is faster in people that have diabetes. So you might need insulin some day. This doesn't mean you have done anything wrong. Its just the normal aging process. Take your medicine, lose wt., eat right & exercise and check your blood sugars every day & get a HbA1c test every 3-4 mo. Keep the HbA1c below 7% and you will do well.
How can I prevent diabetes?
Well you can't change your inheritance or a new family but there are environmental factors you can control. Eat right, exercise & keep your Wt. down to normal for your Ht. This READ MORE
Well you can't change your inheritance or a new family but there are environmental factors you can control. Eat right, exercise & keep your Wt. down to normal for your Ht. This may not prevent it (or it may) but at least following the guidelines can make the genes work better & the diabetes easier to control. Good Luck!
Do diabetics need more sleep?
That's hard to say. It is known that lack of sleep & sleep disorders can help to cause or make worse diabetes. Whether the diabetes can cause lack of sleep is not known. Certainly READ MORE
That's hard to say. It is known that lack of sleep & sleep disorders can help to cause or make worse diabetes. Whether the diabetes can cause lack of sleep is not known. Certainly lack of sleep can make you feel tired as can poorly controlled diabetes. With the latter, there is not enough energy getting into the cell to burn so you feel tired. I would do 2 things: 1) First I would look at your diabetes control & be sure blood sugars are normal or near normal & HbA1c is in a safe range. Also document low BS. 2) see a sleep therapist. They will do some tests & see if you have sleep apnea or other sleep problems. These problems can be treated. So see your physician asap & get tested.
Why did I just get diagnosed with type 1 diabetes now?
Yes DM1 can occur in adults. It happened to me 26 yrs ago at age 57. We used to use the term "Juvenile diabetes" for what we call Type1 now and we called Type 2 diabetes" Adult READ MORE
Yes DM1 can occur in adults. It happened to me 26 yrs ago at age 57. We used to use the term "Juvenile diabetes" for what we call Type1 now and we called Type 2 diabetes" Adult onset diabetes". We have had to stop using these terms because we now are seeing Type 2 in children and Type 1 in adults. So the new terminology. We don't know why this is occurring but it is. Type 1 is still more common in children & Type 2 in adults but there is now a great deal of overlap. Type 2 in children is probably at least partially due to the epidemic of obesity in children. Type 1 in adults is not so well understood but it may be that it was always there & we just mis-diagnosed. I have seen for many years, adults developing diabetes diagnosed as T2 but oral agents were ineffective & they needed insulin much earlier that others. These folks were probably T1 & diagnosed T2 because they were adults. Good luck & keep it under control.
How can I help my son gain weight?
Yes it could be hormones but it could be other things. He may be normal but has genetics for thinness or he may just be a little late for entering the growth spurt that comes next READ MORE
Yes it could be hormones but it could be other things. He may be normal but has genetics for thinness or he may just be a little late for entering the growth spurt that comes next before puberty. A lack of growth hormone could also be the cause.Take him to a pediatric endocrinologist to have him evaluated. He can be tested for hormone lack & this can be treated.
Does gestational diabetes go away after pregnancy?
It may or may not. Gestational diabetes like all diabetes has a genetic component that never goes away. The body needs more insulin during pregnancy so if you have the genetic READ MORE
It may or may not. Gestational diabetes like all diabetes has a genetic component that never goes away. The body needs more insulin during pregnancy so if you have the genetic factor or the environmental factors(obesity & others) you may produce enough insulin for your own needs but not enough for the needs of pregnancy. Af,during the pregnancyter pregnancy you may go back to a state of producing enough insulin to meet your needs so it will seem the diabetes has gone away. But the genetic factor is still there so if you get pregnant again it will reappear. Also you may have, during the pregnancy, lost more insulin producing ability & the diabetes will stay. Even if you go back to normal after the pregnancy remember you still have the gene & the diabetes can progress to prediabetes or frank diabetes with time. To avoid or slow this process, since you can't change your genetics, you must eliminate the environmental influences i.e. obesity, poor eating habits, lack of exercise, etc. I hope things go well for you.
Insulin injections vs. insulin pump?
Yes it would. I don't know her age but she is probably old enough to wear it. Of course she will still have to stick her finger to get blood glucose values so she can control the READ MORE
Yes it would. I don't know her age but she is probably old enough to wear it. Of course she will still have to stick her finger to get blood glucose values so she can control the pump unless you also get a continuous glucose sensor or a Libre sensor. I have diabetes & have worn a pump for 25 years. I wouldn't part with my pump for anything. I also use a Libre sensor so I don't even have to do finger sticks for blood sugar. If she is old enough to understand the pump & how to use it, I would not hesitate to get it with a sensor of some type.
What is the emergency treatment for hyperglycemia?
I must assume that your daughter has Diabetes Type 1. If this is the case and she develops hyperglycemia: Check her urine for ketones. If present then go to the DR. or ER as she READ MORE
I must assume that your daughter has Diabetes Type 1. If this is the case and she develops hyperglycemia: Check her urine for ketones. If present then go to the DR. or ER as she is going into ketoacidosis & will need IV RX. If no ketones she can be treated at home. Treatment involves 2 things: 1) hydrate her with non-sugar containing fluids 2) give her supplemental insulin. How much you give depends on her body weight & previous doses. I would start with 0.1u/kilogram body weight every hour until her BS comes down to a normal or near normal level. The next step is to find out the cause of the hyperglycemia. Does she have an infection or did she miss a dose of insulin. etc.? If she is not diabetic & gets hyperglycemic she should see a Dr to see if she is developing diabetes or has another cause.
What can I do to prevent amputation?
Get checked first as numbness in one foot only may be a pinched nerve in your back. Diabetic neuropathy is usually bi-lateral since it is a metabolic problem. But if it is the READ MORE
Get checked first as numbness in one foot only may be a pinched nerve in your back. Diabetic neuropathy is usually bi-lateral since it is a metabolic problem. But if it is the start of diabetic neuropathy, the first & best thing is to get your diabetes in control. Diab. Neuro. is due to damage to the nerve sheath & the feeding blood vessels due to high BS. Early on it is reversible if BS brought under control & HbA1c brought down to <7 & preferably <6.5. So do whatever is needed to get the diab. under control. There are also meds that can be used so see a DR. Also pay attention to your feet. Inspect them to be sure they a clear of any abnormalities. Look at the bottoms carefully & see a Dr immediatly if you see any abnormality. If you can't see the bottoms of your feet you can get a significant other to inspect them or get one of those poles people use for "selfies" and attach a mirror. YES you can prevent amputation. In fact we are seeing a reduction in amputations because of the above care. OH get your Dr. to inspect your feet at every office visit.
Can type 2 diabetes be completely reversed?
Since diabetes is a combination of an inherited & environmental disease, the answer is No & Yes. You cannot change the genetic factors you inherited so that will always be there. READ MORE
Since diabetes is a combination of an inherited & environmental disease, the answer is No & Yes. You cannot change the genetic factors you inherited so that will always be there. So in that sense diabetes never is "cured". You can, and you have, modified the environmental factors and that may cause a regression of the symptoms of diabetes. Some people think this has cured the diabetes, but if you relax, stop the diet, stop the exercise & gain back the weight (the environmental triggers) the diabetes will come roaring back. So continue what you are doing. Don't let up. Be sure to check your blood sugar frequently and be sure to have your Dr. check your HbA1c often & get it <7 or preferable <6.5 depending on your age. Good luck.
How should I manage my weight with metabolic syndrome?
Weight management follows Newton's law of thermodynamics i.e. Matter & energy are neither increased or decreased in the universe. They are just changed from one form into another. READ MORE
Weight management follows Newton's law of thermodynamics i.e. Matter & energy are neither increased or decreased in the universe. They are just changed from one form into another. So if you take in more matter (food) than you burn for energy (activity) you store is as fat. To get rid of the fat you must either decrease your intake of matter or increase your expenditure of energy. The best is a combination of both. Now there are other factors such as hereditary factors that make it easier for some people & harder for others (I'm one of these). Diet programs are just reminders of what you need to do. Just decreasing portion sizes will do the same thing. That's what Nutrisystem does. Wt. Watchers I think are good because they give incentives for wt. loss and their meetings are good so you can interact (&bare your testimony if you have deviated) and that's good for us. There are also several medications now available to help curb the appetite or prevent absorption of the food. Since you have metabolic syndrome, you could us one of the GLP1 RA drugs you see on TV. such as Trulicity or Ozempic (this is what I take). These drugs are expensive & you may have trouble with your insurance but if your Dr. phases it right you may be able to get one of them. Good Luck!
Is obesity a direct cause of diabetes?
DM2 is a complex disease with no easy explaination. It is a combination of inherited gene or genes and environmental factors. Obesity is certainly a major environmental factor. READ MORE
DM2 is a complex disease with no easy explaination. It is a combination of inherited gene or genes and environmental factors. Obesity is certainly a major environmental factor. For reasons that are not completely clear, fat causes resistance to insulin so the body has to increase the insulin produced to keep the blood sugar down & used properly. With the increased insulin secretion, the pancreas begins to wear out faster & secretion decreases. Then blood sugar will go up-Diabetes. So yes take care of yourself to prevent this extra strain on your pancreas. Diet, exercise & keep your wt. down. You can't change your inheritance but you can control the environmental factors.
Type 2 diabetes in children. Is it because my child is considered obese?
DM2 once was thought not to ever be present in children but it is increasing. 30% or more of our children now are overweight & that is causing "metabolic syndrome" followed by READ MORE
DM2 once was thought not to ever be present in children but it is increasing. 30% or more of our children now are overweight & that is causing "metabolic syndrome" followed by diabetes Type 2 if not controlled. In addition to obesity they also have a gene or genes they inherit for diabetes. You can't change the inheritance but you can control the environmental factors such as obesity and you must or the diabetes will get worse as the pancreas deteriorates due to the need in obesity due to insulin resistance. This overwork of the pancreas will cause it to wear out & decrease or stop making insulin. So control the obesity by diet & exercise (supervised) and take medication such as metformin to control BS & insulin secretion. DM2 in children is very similar to adults except they will have it longer & can thus cause more damage if not controlled. You'll have to work at it but if you do he can live a normal life span. I know of no other cause of DM2 than the inherited genes & environment combination. Work on it & teach him well so he can assume his own management when he is of an appropriate age.
My child has been hospitalized for diabetes complications. Will he be OK?
Diabetic neuropathy is extremely uncommon in children with diabetes, but it does occur. How long has he had diabetes? How well has he been controlled? What were his symptoms that READ MORE
Diabetic neuropathy is extremely uncommon in children with diabetes, but it does occur. How long has he had diabetes? How well has he been controlled? What were his symptoms that caused his hospitalization (we don't usually hospitalize people for neuropathy)? Has he had nerve conduction studies? Diabetic neuropathy is usually caused by long-term poor diabetes control. Neuropathy can be treated with various meds, but the best treatment is to get the diabetes in good control: 1) follow a proper diet 2) exercise regularly 3) check blood sugars at least 4x/d or go on a continuous glucose monitoring system 4) adjust insulin to get blood sugar in the normal range 5) take medicine for the neuropathy. If all this is done, I would predict the neuropathy will get better. It's hard work, but it can be done.
Good luck.
Good luck.