Dr. Richard A. Guthrie, M.D.

No it does not. In a study of pre-diabetes a few years ago, showed that life style change would decrease the chances of progression over 5 years by 60%. Treatment with metformin decreased the chances of pregression to diabetes by 30%. So metformin may help some but is not a good prevention. Your metformin was prescribed to treat PCOD & will have a side effect of lowering your blood insulin (thus removing some hard work by the pancreas) & controlling blood sugar levels (all good) but will not stop what your genetics has pre-determined. Eating right, weight loss & exercise will work better at preventing diabetes than metformin.

Ondero is a new form of an older drug, It is a drug that prevents the breakdown of a natural hormone called GLP-1 that assists in the control of blood sugar. The older form of the drug has been around for several & its effects are well known. I am a little surprised the Dr started this drug early in your treatment. Usually we start with metformin (you didn't tell me if you take this as well), then we add on drugs if metformin & life style changes are not enough. The problem with this drug is that it is not very effective. Studies show a drop of average HbA1c of about 1/2 a point with these drugs & over 1 point with other diabetes drugs . Also "why this form?" it is new & expensive while the older form of it is cheaper & just as effective. A better drug would be the GLP-1 RA itself rather that a drug that just prolongs the life of the hormone. It is expensive & has to be taken by injection but there are long acting form of it that can be taken once a week so no big deal. I would have started you on metformin & if blood sugars are not controlled in 4 weeks add a GLP-1 RA once a week. Don't forget the life style change though. Diet & exercise, wt. loss, etc. is more effective that the medications. Will you be on it for life? Not likely. Overtime there is a progressive loss of insulin secreting ability so we tend to add on drugs & if 3 or more oral drugs will not control the blood sugar the we add insulin. At that time drugs like you are taking are stopped since they are not working. Some oral drugs we continue with the insulin-metformin is the one usually continued. Get a good education about your disease, check your blood sugar frequently, control your wt., then feel lucky you have diabetes & not some more serious problem. Diabetes is not curable but it can be controlled. Remember you are a part of a big crowd of people (31 million & counting) so you have many friends out there with the same problems you have, Talk to them. I have had it for 26 years & am doing well with no complications. I have a good life with just a little added burden from the diabetes. If I can do it, you can do it. But learn as much as you can about the disease and its treatment. A good helper is a membership in the American Diabetes Association & a subscription to its magazine DIABETES FORCAST ( it comes with membership). Membership is not expensive & can be reached at ada.org. Good luck!

Yes you are. If you has gestational diabetes, then in all likely-hood you have some genes for Type 2 diabetes. It is therefore very important that you take steps to prevent or delay the development of the full blown diabetes. The Diabetes Prevention Trial (DPT) showed that treatment with metformin would reduce the chances of progression to diabetes by about 29+% but life style change of diet, exercise, group meetings, etc. would prevent or delay diabetes by 69% for the duration of the study. So talk to your Dr., dietician, etc & get started. The life style change program of the DPT was given to the YMCA and is available through them. If there is

Perhaps it does or maybe you need a different insulin or different timing of your injections. Without knowing kind of insulin, the doses, your body wt., your carb intake, & the time of your doses I can't give you specific advise. There are several possibilities 1) you are taking too much basal insulin. We have always said the basal insulin should be 50% of the total daily insulin but recently experts are saying basal should probably exceed 40% & most people are "over-basalized". So check this out with the Dr. who will need some data to figure out what the problem. Before you see the Dr. check a lot of BS Fasting, 2 hr post meal and pre-meal. Check some also when you feel bad. If the Dr. has ability to fit you with a continuous glucose monitor for 3 days and knows how to read the data it would help immensly. If he or she does not have it maybe they can find someone who can provide this service. Most endocrinologist, especially those with a special interest in diabetes, have this capacity. For your good health get it checked out.

This is a good question to which we have no definitive answer. There are several studies in the literature that say yes, several that say no and many that say maybe. In any event, get your vit. D up & see if it helps. If not look for other problems. If you have been treated since teenager, I would guess you have Type 1 diabetes & take insulin. There are many possibilities here 1) wrong insulin type 2) wrong dose 3) wrong distribution between basal & bolus insulin 4) incorrect carb counting or other dietary calculations. I would suggest some continuous glucose monitoring to determine the problem. An insulin pump with a continuous glucose sensor would be a good suggestion for you. Good Luck

First your low Vit. This may result in low calcium and breakdown of bone with the calcium the becoming deposited in the kidney. This is easy to correct & should. The kidney problem should be followed for signs of progression. Now as to the thyroid. You did not tell me what your FT4 and/or TSH was so I can give you little advice about the thyroid. Ultra sound is good to locate & define thyroid tumors but it is not good for diagnosis of hyper or hypo thyroid. A simple blood test for FT4 & TSH will tell you much more about these. If you have hyperthyroid the FT4 should be above normal & the TSH low as it is suppressed by the high FT4. You should not be treated for hyperthyroid based on an ultra sound alone without the confirmation of the lab. The lab is also needed as a baseline for followup as the FT4 & TSH are used to adjust medication doses or make decisions about surgery or radiation ablation of the thyroid. Get the tests & see a good thyroid specialist as well as a good kidney Dr.

Yes it could be. You did not tell me exactly where the pain in the legs is or what brings it on. It could be neuropathy although this usually starts in the feet & works up. The other possibility is so sclerosis of the arteries. You need to see 1) a good diabetes specialist as neuropathy is reversible , if it has not progressed too far that the nerves are completely dead. Improved diabetes control can reverse it. 2) see a Dr whose practice is periferal vascular disease and get a Doppler ultrasound exam to see if your periferal circulation is ok. 3) see a neurologist and have a electronic test for neuropathy. Above all get your diabetes in good control with what ever means neccessary.

Yes he can consume fruits but in moderation. Fruits contain many vitamins and minerals we need and are a good source of fiber. There are tables available on the internet that will tell you the content of all these in each fruit. One of the highest in sugar and thus should be eaten sparingly is grapes. The high sugar content of grapes is why we make wine from grapes more than other fruits. Bananas are also high in sugar especially if eaten very ripe. If eaten more toward green they contain contain starch that has the same calories as sugar but is absorbed slower as the starch has to be broken down in the gut to sugar to be absorbed. Dates & figs are fairly low in sugar. Also eat the fruit rather than drink the juice as the whole fruit contains the fiber that is not only good for gut motility but also slows the absorption of the carbohydrate so it times better with the diabetes medication. Yes fruits are good and food for you but remember what St. Paul said long ago but still true "moderation in all things." Enjoy

Diabetes is a spectrum of disease that occurs in many forms. Type 1 diabetes is more common in young people and in most cases is the result of a genetic problem in the immune system that (along with some unknown environmental factor that starts the process) in which the immune system attacks the insulin producing cells of the pancreas & destroys the ability of the body to produce insulin. Type 2 diabetes is a spectrum of diseases that usually begin with the bodies resistance to the normal action of insulin causing a larger than normal secretion of insulin. This high insulin secretion rate overworks the pancreas and eventually it can't keep up and the insulin producing cell begin to die and symptoms of insulin deficiency begin to show up. The main problem with both diseases is the lack of insulin either totally or relative to need, results in high blood sugar and poor function of organs that need insulin to function. Organ damage (eyes, kidneys, nerves, heart, blood vessels, brain, etc.) then occurs that is very disabling. Early diagnosis and good control of the blood sugar will prevent the complications of diabetes. It is nothing to be afraid of or worry about. Just follow a good diet and keep the weight normal, exercise, and control any other medical problems. If diabetes still comes, you can live with it (I have for 26 years and am still going strong at age 82). Get a good education and keep the blood sugars normal or near normal & you will do well. AND DON'T WORRY.

The symptoms of early diabetes in the child would be those of Type 1 diabetes what you refer to as juvenile diabetes, a term we no longer use. The symptoms are polyuria (excess urination), polydipsia (excess thirst), and polyphagia ( excess appetite though this is lost as the disease progresses.) Even with the polyphagia there will be wt. loss since there is little or no insulin there food cannot be used & is lost in the urine thus the polyuria. This lack of nutrition even in the face of excess eating will result in fatigue, loss of muscle mass & strength and a complete loss of energy. If any of these develop get him to the Dr & get his blood & urine tested for sugar levels. If found start treatment with insulin immediately. If your family history is of Type 2 diabetes, the the likelyhood of typ1 in your son is very low & I would not worry. If you continue to be concerned get a urine testing kit at the pharmacy & any time you suspect a problem test his urine for sugar. If you find none relax. If you do find some see the Dr. immediately. I doubt he get it but it is not the end of the world if he does. It can be treated today & he can do well. I have had it for 26 yrs so I know you can live well with it. God bless

Yes there is a reason for it. It is called the "Dawn Phenomena" and was first described by a physician Jack Garrich at the Mayo Clinic several years ago. It is due to the production of hormones in the early hours that raise blood sugar. We all produce these hormones (growth hormone & cortisone) sometime in the night or morning (I am a night creature So I don't produce mine until 8 0r 9 0'clock in the morning & like to sleep until 9 or 10 AM. Most people though are not lazy like me & secrete these hormones at 4-6 AM. They are our wake up & get going stimuli & that's good but these hormones are what are called counter-regulatory hormones i.e. they raise blood sugar. So if you secrete a large amount of them in your dawn wake up they can raise blood sugar to high levels in the morning. I don't know what medicines you are on but you need to take some long acting meds probably at bed time to cover the time of the problem. If you are taking insulin & with this problem you would be a candidate for one of the new ultra long acting insulins such as Tresiba (lasts 42 hours) or Toujeo (lasts 36 hours) so the overlap will help with the Dawn Phenomena. Talk about this with your Dr ro find the rig

Two groups of people are at risk of DKA. People with Type 1 diabetes are the main group at risk since they have little or no insulin except what they get from outside. DKA may be produced by errors in dosing (skipping a dose or doses a common trick of teen agers) or by stresses such as infection that increases need. DKA can also occur in Type 2 diabetes mainly in people taking the new drugs in the class of SGLII drugs. These drugs block the reabsorption of sugar out of the urine causing the excretion of the sugar but that also takes water with it so 5they can become dehydrated especially on a hot day suck as today or if they become ill and cannot drink enough. In that case the dehydration causes changes in the liver and ketones are produced. If not corrected DKA is the result. Occasionally Type 2 diabetes can be so severe due to loss of insulin secretion that they will react like a Type 1 when stressed or miss meds & go into DKA. This problem is usually preventable and if it becomes a problem the cause should be looked for & corrected. DKA should rarely be fatal though it continues to be. I have practiced diabetes for 55 years and have never lost a pt. in DKA who was not already pretty far gone when I got them. Find the cause 7& CORRECT IT and have not fear. It can be taken care of.

Several things could be happening but it is hard for me to say which one without knowing what kind of diabetes you have (Type 1 or 2) and what meds you are taking. The most common cause of this problem is that the diabetes has progressed (loss of insulin producing ability) beyond what your medication. This means adding another med. or changing meds to catch up to the need. If you are on oral agents after 12 years they are probably no longer capable of controlling the problem. If we can get 5 years out of oral agents we are doing well (although the new agents we have do last longer). 10 years is a very long time for even the newer agents to work. If you are not on insulin you probably need to be. Insulin always works. That, after all was what worked until you developed a lack of it called diabetes. If you are tasking insulins then maybe you need an adjustment of doses or a different insulin regimen. With the new insulins and delivery systems diabetes is controllable so you may need to advance your treatment. Check your blood sugar several times a day & a few times at night so the Dr can see a pattern of where there problem is & then devise a plan to correct. Your problem is fixable & should be but it will take some effort on your part since the Dr will need data to find the cause. Good Luck

The connection between diabetes & PCOD is true & the insulin resistance of diabetes can affect the PCOD & PCOD can effect insulin resistance & thus blood sugar. It is a vicious cycle & we are never sure where the circle begins only that we need to break the cycle. Here is a simple version of what happens--In PCOD the egg is not forming & being released properly so the body that supports the egg does not produce the estrogen & progesterone it is supposed too. Rather it produces excess amounts of male hormone (testosterone). This hormone when produced in large amounts can cause resistance to the action of insulin thus causing elevated blood sugar that can intern have an adverse effect on the pituitary gland in the brain that produces the hormones that stimulate the egg formation & release of estrogen & progesterone. This causes the formation of the cyst & testosterone production. We don't know where this circle begins- Is it the cyst that starts it by too much male hormone or is it the insulin resistance from over-weight, and/or genetics (susceptability to diabetes) that starts it or some where else in the cycle. Anyway it can be controlled. Metformin can control the blood sugar and reduce the insulin resistance, birth control pills can decrease the testosterone & restore normal female hormones and there are other meds that can decrease testosterone action & insulin resistance. All these meds are generic & cheap & I have found a combination of the to be safe & effective. Don't forget though that breaking this cycle causes an increase in fertility so if you are sexually active & do not want to get pregnant use precaution.

There is no set # that determines when you start insulin. It depends on many factors such as age, life style, goals of treatment, etc. but a1c of 9% is too high if you want to prevent complications such as neuropathy (nerve damage), heart damage, blindness, kidney damage, foot ulcers, etc. But don't be worried about starting insulin. I have been taking insulin for 26 yrs. With modern insulins, and administration equipment, it is a nothing to take. Needles are so small now you can't feel them going in. The one danger is low blood sugar but careful monitoring of diet, exercise and blood sugar levels this need not be a fear. Blood sugar monitoring is easy now with continuous blood glucose monitors or something like the Freestyle monitor. I can't advise you further since I don't know your age, BMI, medicines you have taken or are taking now. I can only say-Get & keep your blood glucose under control & your A1c below 7% and you will be on the road to preventing the disabling & even deadly complications that come from high BG & high HbA1c.

Maybe & maybe not. HbA1c tells us about your level of blood glucose on average, it is not a predictor of the future. By present criteria, A1c of 5.7% or below is normal, 5,7-6.5 is pre-diabetes, and 6.5% or above is diabetes. So with A1c of 5.2% you would be classified now as not having diabetes or prediabetes. That does not mean that you could not develop diabetes in the future. Look at your family history of diabetes, eat a healthy diet, exercise & keep your wt. down to slow or prevent the development of diabetes if you are suceptable.

I can't answer your question without knowing what medications you are tasking. Some medications can do this in some people so it may be the medication. Talk to your Dr. about it & try changing meds (there are lots of diabetes meds out there now). Also check your blood sugar after taking meds or when feeling this way to see if the blood sugar is dropping too fast. If so you may need to change the dose or timing of the medications in relation to food intake. Talk to your Dr. about it as it can be very important.

Watermelon is neither good nor bad. It is how much you eat & when that matters most. Watermelon is mostly sugar water. That's not in itself bad to eat if you don't eat too much & time it with your diabetes medication so it can be covered. As St. Paul said "moderation in all things"

Yes you can. That is the simple answer but the problem is more complex. You need some carbohydrate in your diet and simple cho is not "bad" in itself. Simple CHO is absorbed more rapidly than complex CHO since the complex CHO has to be broken down in the gut to simple CHO to be absorbed but in the final analysis the outcome is the same just the timing is different. Insulin can be adjusted eat either. With the newer insulins we have now, it is not to difficult to adjust the insulin dose & timing to eat simple or complex CHO. Novo now has a new insulin that is ultra fast acting and can (under the right circumstances by people educated in its use) can even be given after a meal after you know how many and what kind of carbs you have ingested. Oats, millet, etc intake is in fact important since you need such foods for calories and for fiber. There is no need to restrict carbohydrate food & you need them. BUT you do need to learn the content & absorption pattern do they can be timed with your insulin. Get a good dietary & medication for your diabetes & never forget what St. Paul said centuries ago "moderation in all things". Good luck

I doubt that this is the effect of the metformin. This drug usually dulls appetite by leaving a small metallic taste in your mouth. I have used the drug on thousands of patients over the years and have not seen wt. gain. It is considered a "wt. neutral" drug. What else are you taking? Many drugs not necessarily associated with diabetes can cause wt. gain. Check with your doctor about this problem. It is important.