Dr. Marvin A. Leder

You are correct that the A1c may be discordant from the blood sugar and should not be used to base treatment. Conditions involved in this situation depend on race, ethnicity as well as multiple medical conditions such as hemolytic anemia with shortened red cell life span. In these situations, I use the venous plasma fasting sugar as well as the two hour post prandial capillary sugar to guide treatment. My goal is a fasting sugar below 120 and post prandial two hours below 180.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Patient,

I like my patients to consider counting carbs at meals to improve diabetic control; breakfast is generally cereal, milk and fruit adding up to about 40 to 50 grams of carbs, which could include 1/2 banana, 1/2 bowl of cereal and glass of milk. I also discuss eggs, but remind everyone that the yolk of egg contains 300 mg cholesterol and like monitoring that dependent on blood levels of cholesterol, egg whites are acceptable to me.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Friend of Patient,

Type 1 diabetic patients can never stop their insulin as their pancreatic beta cells no longer produce insulin. Off of insulin, these patients develop diabetic ketoacidosis, which is a condition that can cause death. I am sure your friend is a type 2 diabetic who, due to poor control, was placed on insulin. This patient has most probably improved due to low-calorie diet and weight loss caused by HCG injections and accompanying diet.

This patient is not a type 1 diabetic; they cannot be off insulin as their pancreas no longer produces insulin. Off insulin, they develop diabetic ketoacidosis, which is a life-threatening condition caused by fat metabolism leading to nausea, vomiting, dehydration, kidney failure, and potential death if not immediately treated with insulin and fluids. This patient is most likely a type 2 diabetic who is on a low calorie diet as well as the HCG injections. Type 2 diabetics frequently have severe insulin resistance due to obesity and weight loss allows their pancreas to produce insulin and for the body tissues to be more sensitive to the insulin lowering the blood sugar level.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient's son,

This is very difficult situation and I empathize with Mom and you. Non-diabetic hypoglycemia can occur in several conditions: Pituitary and Adrenal gland disease, pancreatic tumors, and post eating when the pancreas overreacts to sugar stimulus. It can also occur in alcoholism and malnutrition.
I am unable to answer your questions as I do not know the full clinical picture. The prognosis is unfortunately grim. She is probably receiving supportive nutritional therapy as well as anti seizure meds. You should address questions to her physicians.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

It is most important to do a comprehensive medical history as well as a physical exam when diagnosing diabetes. The lab tests used are the Hemoglobin A1c which, when over 6.5, indicates diabetes. An A1c of 5.7 to 6.4 is prediabetes, below 5.7 is considered non diabetes. In some situations, the A1c is not specific and we use fasting plasma glucose or two hour post prandial plasma glucose. A fasting glucose below 100 is considered normal; 100 to 126 is prediabetes, and over 126 is diabetes; two hour sugars between 140 to 199 are considered prediabetes; over 200, diabetes.

Respectfully,

Marvin A. Leder, MD FACP FACE

The auto immune form of hypothyroidism can occur in families due to genetic predisposition. It is called Hashomotos Diease. Please see your physician and have thyroid function studies done as well as antibodies to thyroid peroxidase to note presence of thyroid autoimmunity.
There are many other non familial causes of hypothyroidism related to iodine deficiency as well as enzymatic defects in producing thyroid hormones.
Respectfully

Marvin A Leder MD FACP FACE

Dear patient,

HypothyroIdism is treated by thyroid hormone replacement therapy. Your doctor will figure out the starting dose and then will increase it till your blood work and clinical status indicate you are controlled. It is important to take the medication daily at least 30 minutes before breakfast and wIthout any other meds you may be on.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear Patient: thyroid evaluations performed by your physician with a medical history, physical exam and thyroid blood work. A throid ultrasound may be ordered if indicated.

Respectfully

Marvin A Leder MD FACP FACE

Dear patient,

You have a difficult problem. The nerves which are involved with smell and taste are located in the gums, tongue, throat, and nose. They are innervated by the cranial nerves which deliver the impulses caused by these smells and odors to the brain. Usually when we smell a food, we get hungry and might want to eat that food. In your situation, the foods causing the odors give rise to a negative feeling, making you nauseous. I would suggest that you could have nerve damage caused by diabetes involving these cranial nerves. I would suggest a neurologic evaluation. Also, you might see nose and throat specialist to rule out problems such as nasal polyps or sinusitis, which might involve nerves.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

Excess urination, severe thirst, and weakness are the first clinical signs of diabetes.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient: You are a treated diabetic; the a1c of 5.2 corresponds to average sugar of 103. The Geminor MP1 is a combination of glimepride,pioglitazone and metformin. If your bmi is not elevated I probably would stop that drug and start small dose of long acting Metformin as the other ingredients in that combination drug can cause side effects such as weight gain or ankle swelling.
Please speak to your physician
Respectfully


Marvin A Leder MD FACP FACE

Dear patient,

Excess thyroid hormone causing hyperthyroidism can cause many issues, including palpitations, sweating, dizziness, weight loss, irritability, or intolerance to warm weather. Dizziness may be lightheadedness or vertigo, which is a spinning sensation on head position change. Please see your physician for evaluation.

Respectfully,

Marvin A. Leder, MD FACP FACE 

Dear Patient,

I am not sure of numbers: is it a free T 4 of 24, tpo antibodies of 256 associated with thyroiditis on scan? A tsh would be helpful, but I am sure it is very low. These numbers indicate that you are in hyperthyroid stage of thyroid inflammation due to the inflammation causing the thyroid to unload its stored thyroxine into blood stream causing symptoms. You should see your doctor, perhaps be referred to endocrinologist consider stopping thyroxine and starting beta blocker to control symptoms.

Best Wishes,

Marvin A. Leder, MD FACP FACE

Dear Patient: I tell my patients they can use their insulin within 10 to 15 minutes of taking it from refrigerator; the injection will be less painful then so please take your insulin.
Respectfully


Marvin A Leder MD FACP FACE

Dear Patient: very difficult situation as there is no cure as far as I know for the condition. The reddened scales and small sores probably mean infection and should be treated with appropriate antibiotics. Diabetic control should be very good; a1c 7 in order to properly help control infection. From your note it appears that you are doing all possible. I would suggest being followed by a dermatologist as well as your regular physician.
Respectfully


Marvin A Leder MD FACP FACE

Dear Patient,

Tingling after eating may be related to a large carbohydrate meal which affects the nerves in the body, causing neuropathy; the feeling of weakness several hours later could be due to low sugar levels. You should see your physician and discuss the sugars before and after eating; the foods you ate before the tingling sensation over your body and your meds.

Best Wishes,

Marvin A. Leder, MD FACP FACE

Dear patient,

If Mom is Type 2 diabetic, there is a very close genetic relationship of you getting the disease. To avoid getting diabetes, you should maintain a healthy lifestyle, including diet and exercise. If Mom is a type 1 diabetic, there is little likelihood of her passing it to you.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient,

Good question, diabetes is managed at work as it is at home. Diet is unchanged; low carb, low saturated fats, plant foods. Glucose monitoring is done at work either in your own work space or bathroom. If on insulin, prior to meals it is administered in your work space or bathroom. Oral meds can be taken prior to going to work or on coming home before dinner depending on your regimen. Weekly injections are given at home. Work is no problem for most folks; situation is more difficult if you work at night as schedule needs changing.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patient: your hiusband should be seen as soon as possible to have his nose,throat,lungs examined and a chest x ray. As a former smoker he is susceptible to many illnesses related to smoking.
Patients who are treated for high blood pressure or protein in the urine which are common in diabetics may be placed on certain drugs which can cause a cough, but the evaluation must be done to be sure no disease is present.

Speak to your physician as soon as possible.

Respectfully

Marvin A Leder MD FACP FACE

I think we all should be concerned about Covid and take preventive measures. Your family’s diabetes should not place you at increased risk. However, you should be aware as to possibly developing diabetes in the future and maintain a healthy body weight with diet and exercise.