Dr. Marvin A. Leder

Dear patient,

The glucometers purchased at the pharmacy are accurate. Intermittent fasting with then overeating will lead to weight gain, more insulin resistance, and elevated A1c. It is best to be on a low-carb, low saturated fat diet to lose weight and improve diabetic control.

Respectfully,

Marvin A. Leder, MD, FACP, FACE

Dear Patient,

Proper evaluation would include blood sugar at time of event as well as body minerals such as potassium, calcium, and magnesium. Hypoglycemia can cause palpitations, tremors, lightheadedness, hunger, and sweats. I don't recall stiffness, but anxiety is common and may be involved. Also, would like to know type of insulin being used and the time after injection and length of time stiffness lasts.

Respectfully,

Marvin A. Leder, MD, FACP, FACE

Dear Patient,

Diabetics are susceptible to chronic sinus infections, especially if they are poorly controlled, A1c over 7. Fungal infections can cause thick mucus. She should be seen by an Ear, Nose, and Throat specialist for evaluation. She is on Diabeton, which is an oral hypoglycemic. The insulins used now are generally synthetic and cause few adverse reactions apart from low sugars.

Respectfully,

Marvin A. Leder, MD, FACP, FACE

I would not wait until Monday you be seen as soon as possible. This may be an Infection, gout or a Charcot foot which is a complication of a severe sensory neuropathy causing bone fractures in the foot, inflammation, pain, swelling, redness.
Please don’t wait ;get immediate care

Marvin A Leder MD FACE FACP

Dear Patient,

There was a rapid acting inhaled insulin named Afrezza which was on the market for several years, but was recently taken off by Sanofi because it didn't sell. It is a short acting insulin to be used at meals. It is not a basal insulin, which works over 24 hours and is only injectable. I didn't like using it because of the potential for lung damage in certain populations and its side effects included coughs and sore throat. A pulmonary function study was necessary prior to use. The injectable insulin pens are easy to use and have had great patient acceptance.

Respectfully,

Marvin A. Leder, MD FACP FACE

Dear patent,

Most importantly in your situation is to maintain a normal body weight for your height; excess body weight leads to insulin resistance which leads to diabetes. The Diabetes Prevention Program was a major research study which demonstrated in people with pre-diabetes that a 7% weight loss in association with at least 150 minutes of exercise each week led to markedly decreased rate of diabetes in the population studied. Ten years later, those people who maintained the weight loss had about a 25% decreased rate of clinical diabetes than those who gained weight. Speak to your doctor or nutritionist about a low-carb, low-saturated fat diet, and exercise.

Respectfully

Marvin A. Leder, MD FACP FACE

Dear Patient,

Remission of diabetes is defined as normal fasting sugar below 100 and two hour post-prandial sugar of l40 or less of all medications. I have had several patients achieve this goal through vigorous weight loss of 5 to 7% as well as exercise. The key is weight loss as this reduces insulin resistance which is one of causes of type 2 diabetes, the other being pancreatic beta cell decrease in insulin secretion. The key is weight loss. Speak to your physician about seeing a nutritionist.

I would just like to mention, The Diabetes Prevention Program Study which studied prediabetic patients found that those who reduced weight by the above amounts had a much lower rate of developing diabetes; about 58%. Ten years later, those patients who continued their diet and exercise showed a continued reduction in progression to diabetes.

Respectfully,

Marvin A. Leder, MD, FACP, FACE

Dear patient,

If you have type 1 (insulin dependent diabetes which is due to auto immunity) you do have a higher chance of developing auto immune hyperthyroidism as well as other autoimmune disorders. In type 2 diabetes, there is no connection with hyperthyroidism except that it can worsen diabetes if the hyperthyroid condition develops. Hypothyroidism due to its effect on metabolism, e.g., weight gain, effect on insulin secretion can lead to diabetes.

Respectfully,

Marvin A. Leder, MD FACP FACE

Uncontrolled diabetics with very elevated blood sugars lose sugar in the urine; this leads to weight loss. Weight loss is one of the primary symptoms of type one diabetes or very poorly controlled type two diabetes. The major symptoms in these patients are excessive urination, excessive thirst associated with weight loss, and fatigue. When the diabetes becomes controlled, the patients gain weight.

Yes, diabetes type 2 in the presence of excess calories both carbohydrates and fat along with insulin may result in fatty liver. Severe degrees of fatty infiltration of the liver can lead to cirrhosis and its complications. Prevention of fatty liver involves restriction of fat and carbohydrate intake, weight loss, avoidance of alcohol, control of blood sugar, B vitamins, and, recently, the use of victoza.

Respectfully,

Marvin A. Leder, MD FACP FACE

Good question. No, it doesn't mean that you will never develop diabetes. The Diabetes Prevention Program studied several thousand prediabetic patients for several years breaking them down into two groups; one which was placed on Metformin 850 twice a day and other on diet with goal to lose 7% of their body weight along with exercise, combination of both called lifestyle changes. These two groups were compared to a prediabetic group receiving no care or placebo meds. The diet and exercise group demonstrated an over 50 percent reduction in the development of diabetes and in those who did develop the disease a delay by several years. The metformin group also showed a decrease in the number of people who developed diabetes by 30 percent with a similar delay in onset in those who went on to develop the disease. However, type 2 diabetes is a progressive disease involving both beta cell dysfunction (insulin producing cells) and insulin tissue resistance and this progressive nature was shown in further studies when the metformin was stopped.with the development of diabetes.
Your take home message is to diet, exercise and take metformin to delay the development of diabetes.

Respectfully,

Marvin A. Leder, MD, FACP, FACE

Dear Patient: Very difficult question and answer. TPO antibodies may fluctuate over time; I have seen thyroid disease in people with low titers as well as high titers; I have some patients with high levels who have no disease. It is thought that the antibodies rise due to some trigger either diet e.g. gluten or dairy products, stress, vitamin D deficiency (levels higher than needed for replacement therapy to prevent bone loss), infections, hormonal changes or perhaps other auto immune diseases which you don't describe.

You are on a gluten-free diet; perhaps seeing nutritionist about other dietary triggers and taking vitamin D with levels of 50 would help in avoiding spikes. You should keep your regular appointments with your physician for follow up on thyroid problems or other issues related to immune system.

Respectfully,

Marvin A Leder, MD, FACP, FACE

Dear Patient: Type 1 and 2 diabetes have these major differences and similarities:

Type 1 dm is due to the absolute loss of the pancreatic beta cells which produce insulin these people must use insulin to treat the disease. It can occur at any age but usually occurs in young people. The inheritance pattern is different in that it is not passed down from grandparents to parents to child to siblings as in type 2. Type 1 diabetics may not have any relatives with the disease or there may be some distant relatives with the illness.

Type 2 dm is due to the slow deterioration of the beta cell (insulin producing cell) over time and insulin resistance which is the inability of tissues of the body to dispose of glucose (sugar). This could be due to genetics but generally is due to obesity with fat in tissues interfering with the insulin tissue disposal mechanism of glucose metabolism. The similarities of both diseases relate to complications if the sugar level is not controlled such as eye, nerve, kidney tissue damage as well as cardiovascular problems.

Treatments differ in that type 1 patients require insulin immediately while type 2 patients can receive oral hypoglycemic agents til the disease progresses and they need insulin or other injectables.

Respectfully,

Marvin A Leder MD FACP FACE

Dear Patient: Yes, you are at risk for developing type 2 diabetes if you had gestational diabetes. You should see your physician periodically for blood work and discuss how to lower risk for diabetes. Being overweight is a major factor in developing diabetes over the years after pregnancy.

Respecfully yours,

Marvin A Leder MD FACP FACE

Dear patient:



















Dear Patient:

elevated sugars in the morning on awakening are usually due to insulin resistance causing the liver to make large amounts of sugars overnight; it may also be due to eating large dinners late at night usually after 8 pm. Another reason could be nocuturnal hypoglycemia with morning rebound hyperglycemia.thought to be due to too much insulin at night prior to sleep.
You need to keep careful records of food intake, time of eating, blood sugars,time when taking meds for diabetes and then of course carefully discuss with your physician to make changes in your treatment regimen.
Respecfully
Marvin A Leder MD FACP FACE

Dear Patient: Have your doctor refer you to a nutritionist to discuss diet or google it on internet, but best to see nutritionist.for proper understanding of diabetic diet.
Respectfully
Marvin A Leder MD FACP FACE

Dear Patient: the inability to awaken Mom is likely due to damage to cerebral function possibly as a result of hypoglycemia (low sugar); the counter-regulatory response to hypoglycemia could be associated with a rise in blood pressure. It would be helpful to know what her sugar is when she cant be awakened as well as blood gases as she does have copd and could have ventilation problem. It would be useful to know her pulse rate, blood sugar and if she is clammy during episode. She is on multiple meds that can cause drowsiness such as gabapentin, nemantine and donazepril. If her blood sugars are not low during episodes she requires full neurological evaluation. If she is hypoglycemic her insulin regimen must be reevaluated and changed.

Respectfully

Marvin A. Leder, MD FACP FACE

Dear Patient:

I would be concerned about hypoglycemia( low sugar) as this is an adverse effect of several of the meds used to treat diabetes and which could cause your symptoms. A finger stick sugar should be done when these symptoms occur, and of course you should consult your physician who knows you.

Respectfully,

Marvin A. Leder, MD, FACP,FACE

Dear patient: 1 cup of watermelon contains about 12 to 15 grams of carbs in it. It can easily be intergrated into your dietary program.
To properly control your diabetes you should know which foods contain carbs, the different types of carbs with respect to the glycemic index of the food( this is an index showing the rate of rise of blood sugar with different carbs) and the quantity of carbs allowed in your dietary prescription. To get the requred knowledge to do well please ask your doctor to refer you to a nutritionist.
Respectfully
Marvin A Leder MD FACP FACE

Excellent question; it goes to heart of the matter which is insulin resistance; this is what occurs with high insulin levels which produce obesity,which is a major cause of insulin resistance, as well as other complications of diabetes. Consuming complex carbs which are low glycemic index foods means slower digestion and absorption of carbohydrates with lower blood sugar and insulin levels which help to prevent insulin resistance by having an impact on obesity as well as on insulin receptors.
Complex carbs include foods with nuts, seeds, unrefined whole wheat breads and starches as well as high fiber veggies.and omitting processed foods. I believe that is the ideal diet but you must realize that the carbs are carbs and they must be restricted to prevent too much insulin release and wt gain. That is the trick
have your physician refer you to a nutritionist to find out more details of a low glycemic index diet.
Respecfully

Marvin A Leder MD FACP FACE