Dr. Marvin A. Leder

Dear patient,

Golo is a diet plan with a plant-based supplement. Its effects are thought to be due to the low-cal diet it employs, which will reduce blood sugar and insulin needs due to weight loss. I doubt that the plant supp has any effect on blood sugar.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Patient,

There are many different types of insulins available. Their shelf lives are usually indicated on the brochure accompanying the prescription. In clinical practice, I ask my patients to renew their insulin when they estimate they have a week left.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Patient,

A tsh of 2.84 is within the normal range of 0.5 to 4.5 in non-pregnant females. The levothyroxine should be taken 30 minutes before breakfast and apart from any other meds. The Dilantin can interfere with the effect of thyroid meds and may be resolved with a larger dose of thyroid. This complex situation requires careful discussion with your physician and perhaps a referral to an endocrinologist.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

Weight lifting is thought to be beneficial; its advantages are building muscle mass, which improves insulin sensitivity as well as decreasing body fat in combination with proper diet.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Patient,

Sorry for your distress. A small percent of adrenal adenomas may be functional, which means they are secreting hormones such as cortisol, aldosterone, noradrenaline or adrenaline.These hormones could cause symptoms as well as being cause of hypertension.You should discuss this with your physician and be evaluated for these hormones.

Respectfully,

Marvin A. Leder, MD FACP FACP

Dear Patient,

Low sugar, or hypoglycemia, can be caused by too much meds, especially insulin or sulfonylureas or anti-diabetic drugs combined with insulin. Other causes include exercising at time of maximal effect of anti-diabetic drugs or drastic reductions in carb intake. Please discuss this issue with your physician.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Mother,

I certainly understand your concern; your daughter should be seen by an endocrinologist to evaluate her problem. The ovaries or adrenal glands may be producing too much male hormone, which can cause excess hair as well as menstrual disorders and acne. If those tests are within the normal range, then it can be considered to be a family trait. Depending on the findings, treatment programs can be established.

Respectfully,

Marvin A. Leder, MD FACP FACE AW

Dear Patient,

Your symptoms fit the description of Restless Leg Syndrome, which is associated with diabetes and neuropathy. You should see your physician as treatment is available.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Patient,

I try to keep carb intake at bedtime between 15 to 30 grams of carbs to prevent nocturnal hypoglycemia, especially those patients on long-acting insulin, as well as to prevent fasting hyperglycemia. Low-fat cheese and two to three whole wheat crackers or small portion of fruit usually work.

Respectfully,

Marvin A. Leder, MD FACP FACE

Yes, you can develop both type 1 and 2 in later life.

Respectfully,

Marvin A. Leder, MD F A C P F ACE

Dear Patient,

Whether you need meds will depend on your A1c, which is a marker of diabetic control. Importantly, diabetic complications begin at a level of 6, which equates to average sugar of 136 all day. While an a1c of 7 is goal for most patients. I start patients with recent onset diabetes on meds when the a1c is above 6 to prevent those complications. In starting meds, awareness of susceptibility for hypoglycemia is always considered in the decision making. I am glad your numbers are good due to diet and exercise, but check A1c with your physician.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

If the 250 is an occasional occurrence, it is probably due to overeating carbs. If this is a daily problem, it is important for you to visit your physician for review of meds and lifestyle including diet and exercise. If the spike to 25O is associated with excess thirst, urination, dizziness, or blurred vision, medical attention should be immediate.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Patient,

In type 1 dm, most wbc counts are normal or even lower. There are some autoimmune diseases that increase the white count, but type 1 diabetes is not one of them. I believe the autoimmune response is ongoing till the death of all beta cells; Glucagon like peptide agonists have no place in treatment of type 1 dm; there is some experimental evidence that they may play some role in alpha cell secretion, but it has not been refined to clinical levels; I can tell you that when they first came out, I tried them in several type 1 patients with no good results. This, I believe, is the experience of most endocrinologists; they may cause weight loss in those type 1s who have gained weight. Glucagon levels in type 1 diabetes are usually increased; there is not the non diabetic normal response to lowering of the sugar level, therefore, you must rely on either sugar or glucagon injections to return blood sugar to normal. Maintain strict vigilance to maintain normal glycemica. I have found continuous glucose monitoring to be very effective at this time. Remember, you are dealing with abnormal physiology of pancreatic beta and alpha cells.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

The early symptoms of hypoglycemia can include shaking, sweating, palpitations, dizziness, hunger...the late symptoms include mental changes such as memory loss, confusion, and coma. If your child is on insulin, he should be familiar with the time of its activity, need for not missing meals, effect of exercise on sugar levels, as well as treatment of early stages prior to mental changes. You should discuss these factors with your doctor.

Respectfully,

Marvin A. Leder, MD FACP FACE

Not a good idea as this will cause spikes in blood sugar interfering with good control. Depending on amount eaten, weight gain may be a problem.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

Loss of pancreatic beta cell function with marked decrease or absence of insulin secretion causes elevated blood sugars in children most commonly caused by an autoimmune disorder affecting those cells. Other causes include genetic disorders of insulin secretion as well as marked obesity and insulin resistance.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

Sorry for this problem, but the frequent urination can be due to several issues which need consideration: First, is your diabetes controlled, as blood sugars over 180 may cause frequent urination; secondly, chronic infection with blood in the urine can cause frequency, even though painless. The blood may also reflect a disease process occurring in your urinary system such as a polyp, stone, or tumor. Third, difficulty emptying means an obstructive process or bladder abnormality. You should see your physician to have blood sugar control evaluated and to see if you need further referral to urologIst and gynecologist to rule out infection, pathological defect in urinary system, or obstruction.

Respectfully,

Marvin A. Leder, MD FACP FACE

Common symptoms of uncontrolled diabetes include weakness, thirst, excessive urination, blurred vision. These symptoms are commonly found in type 1 diabetics and very poorly controlled type 2 diabetics. Type 2 diabetics frequently don’t have these symptoms, but those patients who have a strong family history of diabetes, may be obese, have had diabetes during pregnancy, have high blood pressure, and should be seen by their physicians to rule out diabetes.

Dear Patient,

The Astra vaccine has not been approved yet in the United States. When approved, it will be a positive contribution against Covid. He should get the available vaccines as he has the underlying medical conditions making him susceptible to severe illness. It is also of importance that he keep his diabetic control as perfect as he can.

Respectfully,

Marvin A. Leder, MD FACP FACE

The warning signs of diabetes are excessive urination without pain, thirst, lightheadedness, blurred vision, wt loss...these are signs of severe glucose intolerance with very elevated sugars. In people without these findings, they may be diabetic also, but need to be tested to determine their glucose tolerance. Most of these people have risk factors for diabetes, which include obesity, high blood pressure, elevated blood lipids, kidney disease, family history of diabetes or belong to an ethnic group with high prevalence of diabetes.
Best to see your doctor to discuss these factors.

Respectfully,

Marvin A. Leder, MD FACP FACE