Dr. Richard A. Guthrie, M.D.

Well the good news is you don't have "borderline" diabetes. The bad news is you have Diabetes. First of all "borderline diabetes" is an obsolete term we don't use anymore. The term for an early state of diabetes today is Pre-diabetes. Here are the criteria FBS <100 normal, FBS 100-126 Pre-diabetes, FBS >126 Diabetes Mellitus. So with a FBS of 140 you are beyond pre-diabetes and have diabetes. Start treatment now. 1) get advice on diet and exercise (we call it life style change 2) start medication. 3) Get a good education course on diabetes 4) get a HbA1c test if not already done. At this level of blood sugar, most physicians would just start Life Style change. I would do that but add the medication metformin. This drug has been in use for decades and has few side effects, control BS, & is generic so is very cheap. Its time to start so see your Dr. & get going before it gets worse as it will without working to keep blood sugar as near normal as possible.

Brown rice may be helpful in controlling BS but is not a miracle treatment for diabetes but it may help. Brown rice is rice with the coat still on (not polished yet) and the husk has a high fiber content that helps control the absorption of sugar from the gut. To me it is not as tasty as polished rice but that is a personal taste. If you like it, use it & it may help. Don't depend on the rice alone however. Check BS, have Dr check HbA1c, and get appropriate medication, life style change & education.

This is somewhat curious. Janumet is a combination drug that contains 2 drugs-Januvia and metformin. Both drugs were wt. neutral in controlled studies. If this is the cause of the increased appetite & wt. gain, then the best course is to change medicines. There are now about 20 drugs to treat diabetes & many of them cause wt. loss. In this case, a change to a GLP 1 Receptor Agonist might be best. These agents decrease appetite & usually cause wt. loss. There are several of them on the market- Short acting ones you take 3-3x/d. Intermediate acting you take once daily ( the most popular), & long acting ones you take once a week. The disadvantage to these drugs is they must be taken by injection. They come in a pen with a very tiny needle that you can barely feel so no big deal (I am diabetic and take a once a week one & I cannot feel the needle when I give it). Another disadvantage is cost so look into your insurance. Check with your Dr. about a once daily (such as Victoza) or a weekly one (such as Trilicity orBydureon or a new one called Ozempic). These drugs cause nausea at high doses so start at a low dose and gradually go up. They control blood sugar & wt. loss. Be sure to check blood sugar frequently especially while titrating the dose up & stay at the minimum dose that controls the blood sugar.

Yes. There are many articles in the literature recommending yoga for people with diabetes. Yoga does 2 things (maybe many more) 1) it can substitute for the exercise part of your life style change program 2) can bring some mental help that will help with blood sugar control. A lot of high BS is brought about by mental stress that causes the release of the hormones epinephrine, norepinephrine and cortisone. These hormones raise blood sugar. Yoga helps us to cope with problems that might cause the release of these hormones thus keeping BS under control. You should ,of course keep up the proper diet & other life style changes your Dr. has prescribed. Yoga is a supplement to the other aspects of your program

The answer to your question is yes. Sometimes the body becomes resistant to absorbing or using the medication. Most often, the cause of loss of effectiveness is the loss of function of the pancreas. The pancreas produces insulin and the insulin causes the absorption of the glucose into the cell for its metabolism. Most of the diabetes drugs work by stimulating insulin secretion by the failing pancreas or work by making the insulin work better at the cell level or a related activity. With time, we all lose some of the cells (called beta cells) of the pancreas that make insulin. People with diabetes lose them faster than others so as the insulin production goes down more or different meds are needed. I'm suprised she has stayed on the same med for 20 yrs. For oral meds, usually a few months or a year or 2 is all we get and a 2nd or 3rd drug is needed. If we can get 5-10 yrs out of oral meds we are lucky. I wonder about her level of control and how attentive her physician has been to her level of control all those years. What is her HbA1c and is she checking blood sugar levels frequently? Keep sugar down & HbA1c less that 7-7.5% to prevent complications. (The range for A1c depends on age & you didn't tell me her age). If she is not in range, talk to her Dr. about more or different meds. There are about 20 on the market now so the tools are available for good control & prevention of complications.

See a Dr. right away. Her feet need diagnosis and care or she may lose them. Blood flow needs to be checked by doppler, reason for edema (congestive heart failure or a variety of other causes). Get her diabetes under control & get medical care for the feet by a physician and/or podiatrist right away.

Yes, you can, but consult your Dr. as to which ones. Many of the supplements on the shelf are worthless & a waste of money. The most advertised ones are often the most worthless and are really scams. So be careful & follow a physician's advice.

Glycomet SR is just long acting metformin. Metformin is not really a wt. loss drug. It may help a little by some actions on the GI tract and its flora. Metformin also leaves a slight metallic taste in the mouth that often decreases desire to eat. This designed to lower blood sugar & not for wt. loss. If you want or need to take metformin or metformin or its long acting form you can get the cheaper as a generic drug rather than as a brand name drug & the generic is as good.

See a Dr right away and get the boil lanced & drained and get antibiotics. Second, get your blood sugar down and your A1c under control. A high A1c dampens your immune system & inhibits its ability to fight infections. High A1c also causes damage to your blood vessels & nerves, causing even more complications. A1c should be below 7% (ADA criteria or 6.5% AACE criteria) to prevent these serious, life-threatening complications. Do whatever you need to do (change or add medications, change lifestyle, or add insulin if not now taking) to get that A1c down. Check blood sugars regularly & work at it for better control.

This is not a easy question. We know so little about leptin & all its effects & sensitivity to it. Continue the exercise program & talk to a dietician about your diet. The YMCA has an excellent program for diet & exercise at a fairly cheap price. If you have an available Y, this a good place to start. You have PCOD, but did not tell me if you are on drugs. Some help with wt. control & some have the opposite effect. Talk to your Dr. about your medications & get adjusted if needed.

Don't be scared. See an endocrinologist who specializes in thyroid disease for control. If the thyroid is controlled, there is no more fear of miscarriage than expected in others your age. Thyroid needs to change during pregnancy, so see a knowledgable physician to manage the problem & check the values frequently as they do change as pregnancy progresses. Good luck!!

An HbA1c is much too high for anyone & must be lowered. You didn't tell me how old your mother was & what meds she is taking so I cannot completely answer you? But only speak generally. And here it is INSULIN. At this level of control, & duration of diabetes, probably only insulin will control her. She needs to see a diabetes specialist for 1) diet & exercise counciling 2) start insulin if she is not taking it now & if taking it adjust the dose & distribution of the doses. If I were seeing her & she were on oral agents I would stop all of them except metformin and starty a basal-bolus insulin regimen with a long acting insulin at night & short acting insulin before each meal. Test blood sugar 4x/d and adjust insulin as needed to get blood sugar under control & HbA1c down to at least 7.5 or 7 depending on age. Yes, it is causing complications & she must know that and get help. Early complications are reversible, but if they go on, can become irreversible and very disabling and even fatal. Get her help right away.

It could be, but likely is not. How do you know what you are losing is muscle fat and not muscle itself? There are tests that can tell the difference. Ask your Dr. to get those tests first. If it is fat and not muscle loss, then have your Dr. test testosterone, thyroid, and perhaps pituitary hormones. You did not tell me how old you are, how tall your are, your wt. -- all of which I would need to know to give you a better answer.

There may or may not be. High cholesterol and thyroid disease can occur each on its own, but they can also occur together. A high TSH indicates a failed or failing thyroid. That means that the thyroid hormone that controls a lot of chemical reactions in the liver (where cholesterol is made) as well as chemistry of the rest of the body. If thyroid is low, then the chemistry of the liver (and other organs) do not work well and a high cholesterol may be the result. What should you do? 1) get your thyroid under control and in normal range for free T4 & TSH. 2) Then, see what your cholesterol does. If still high with control of thyroid, 3) then treat the cholesterol with anti-cholesterol drugs such as a statin.
RAG

Without seeing your lab values I cannot give you a definitive answer but only a general one. If your Hashimoto's was mild you may have a remission due to pregnancy hormones (thyroid can change a lot during pregnancy). In which case the Hashimoto's may come back when not being suppressed by pregnancy hormones but not necessarily worse. Just be sure you have free T4 & TSH checked frequently during the pregnancy (for the babies sake) and after pregnancy and adjust thyroid medicine

The simple answer here is eat less & exercise more. But it is not so simple. Diet & exercise are very important & should be a part of the program but other factors may also be in play. I do not know what meds you are taking but some of them do encourage wt. gain. Talk to your Dr. about that. A good med for you might be a GLP1. These drugs are injectable but usually depress appetite & cause wt. loss. Talk to your Dr. about going on one of this class of drugs. There are several with different injection patterns-2x/d, daily, or weekly. There are also wt. loss drugs available now that might help. The answer to the question "will wt. loss help the diabetes" is yes it will. The more overwt you are the more insulin resistant you become and the more meds you need. Some of the meds can stimulate appetite so you eat more & gain wt & need more meds. So 1) diet & follow it-see a dietician 2) set up a daily exercise program-The YMCA is a good place to start-but follow the program 3) talk to your Dr. about meds that fascilitate wt. loss particularly GLP1 drugs. Good Luck.

Lack of sleep & sleep disorders have been associated with the development of diabetes & worsening it in those who have had it. See about changing your work habits & see a sleep specialist for further help.

Your question is a good one & it is commendable that you are willing to hire these people & be willing to treat them. So many people will discriminate against them. We have been working hard to counter this discrimination and you are to be commended for helping them. A BIG THANKS. Now, treatment--1) prevent when you can. To do this allow employee to test blood sugar as needed and to eat snacks when needed 2) if treatment is needed-supply sugary drinks if the patient is able to drink & follow with solid food. 3) be sure the patient has or you have available treatment supplies--these include sugary drinks, snack foods, plain table sugar, candy, etc., and glucose tablets or gel which can be held under the tongue. They are available over the counter in any drug store. Be sure an employee has them on hand & know where if the person is unable to talk. 3) allow employee to rest and recover after the feeding. 5) I don't know your state so I don't know your laws. In my state (Ks.), we worked & got the law passed to allow non-medical people to administer a drug called glucagon. This drug is given intra-muscular, so can be given in the arm, etc., and is non-dangerous, but will cause the liver to put out sugar & bring the blood sugar up. This would be used if the patient is unconcious & unable to take oral fluids. It comes in a syringe & bottle. The glucagon is in a freeze dryed form in the bottle. Inject the fluid in the syringe to dissolve it. Then, draw the fluid back out into the syringe. For an adult, inject the whole syringe full into a muscle like in the arm, and the patient will wake up in 15-20 min. If the drug is given when it is not needed, there is no danger, the patient will just have a high blood sugar they can correct themselves. The drug does have a side effect, however, & that is nausea, so the patient should be allowed to rest & take in small amounts at a time of fluids. The hypoglycemia itself may leave them with a headache. This is not a side effect of the glucagon, but of the hypoglycemia. After glucagon is given, call 911. But give the glucagon first & the employee may be fine by the time EMS arrives. A good thing. Do not panic! Hypoglycemia can cause seizures & unconsciousness, but it is rarely fatal. Protect the person from falling or otherwise injuring themselves as they lose control. This is the single most important thing you can do. Protect against injury. Then treat as above. First step-Protect from injury. Second step-Glucose tablets or jell under the tongue. Sugar fluids if awake & can drink. If they cannot take oral fluids, then glucagon (if law allows) and call 911. I hope it never happens, but good luck if it does.

This is a good question. You will come in contact with many people who will say "Well, I did this and cured my diabetes." Be careful. Diabetes is an inherited disease and we can't present change our genes (that may be coming soon, but not now). Therefore, diabetes cannot now be cured. The genes are always there. Lifestyle modifications however can change the manifestations of diabetes. Diabetes is a genetic disease that manifests itself through environmental factors. We can't change the genetics, but we can change the lifestyle and thus modify the manifestations of the disease and its damaging effects. The lifestyle change (Wt. loss, exercise, etc.) will lower the elevated blood sugar & thus prevent the complications (blindness, kidney failure, probably heart disease & stroke, amputations, etc.) but will not cure the diabetes. A relapse of lifestyle change (gaining too much wt., lack of exercise, etc.) will result in a re-manifestation of the genetic disease since it's there in the background forever.

Be careful of dietary advice from anyone. Almost all sources of information have their own biases. Read widely and make informed opinions & actions. As to beet juice, I also have a bias. I don't like the taste, though in V8 juice it's not bad. The data I have found suggests beet juice has beneficial effects such as anti-inflammation, etc., that can protect from heart disease & more. The bad effects are vocal cord effects, kidney stones, chills, fever, and rash. The latter 3 are signs of allergy to it & can be cured by not using. Kidney stones seem to be the most common side effect so anyone with a history of kidney stones should stay away from it. I doubt though that his drinking it had anything to do with his diabetes and as St. Paul said, "Moderation in all things..." can apply here. Beet juice has some beneficial effects, but like all things, too much of a good thing can be a bad thing. The amount of beet juice in V8 is modest and is probably beneficial & relatively free of side effects. It is also more tasty that boot juice alone or even in pills. Beet juice or beetroot juice is high in fiber & may help bowel problems. Don't forget that beet juice & beetroot juice (the same thing since beets are the root of the plant) are red so they may turn the stool or urine red. That may scare some people, but it is harmless.