Dr. Richard A. Guthrie, M.D.

This is a difficult question. I have spent the last 50 yrs.. of my life trying to answer it. A 13 yr. old is in a state of transition from childhood to adulthood with all the emotional problems of teenage. Add diabetes to that & you have a problem. It is impossible in this limited space & without details of her behavior to tell you what to do. I can only be generic in my comments. 1) have her go through good diabetes education with a good diabetes educator who is familiar with the problems of teens 2) make the diabetes management as easy as possible using modern tools such as continuous glucose monitoring, insulin pumps, etc 3) find a peds endo who knows how to use these instruments & understands teens. 4) if severe problems develop find a child psychiatrist who understands teens & diabetes in teens. Always be loving & kind. Diabetes is hard for anyone but especially hard for teens. A Diabetes Camp experience may also help. All the best, I hope she accepts her disease & does well.

Some people can. It depends on how many beta cells that produce insulin are left and how much insulin resistance there is (related to the degree of obesity). I wouldn't fear being able to get your meds during COVID 19 since pharmacies are considered vital & will stay open. Most also will deliver so you won't need to go out. Exercise & follow your diet just as always & you should do OK

Yes, it does. Diabetes tends to compromise the immune system so you are more susceptible to infections of all types. COVID 19 seems especially prone to hit hardest in those with co-diseases or impaired immune systems. So take all precautions as outlined by the CDC. Stay home & avoid contact with potential carriers. Until we find a treatment or cure or a vaccine that's about all we can do.

Some people can & some cannot. You didn't tell me your wt. so I can only speak in general. If you still have beta cell that make insulin & thus insulin resistance associated with obesity the answer is yes you can probably control the diabetes with diet, exercise & wt. loss. Medication may be needed until you have lost enough wt. to reduce insulin resistance but then you may come off meds. Remember though that diabetes is an inherited disease and you cannot change your genetics. So if you are successful in controlling your diabetes without meds, if you regain the weight, stop exercising & dieting the diabetes will be back with a "blaze" So don't stop!!

The answer to this question is YES & NO. Diabetes Type 1 & Type 2 are inherited diseases and we cannot change our genetics. Maybe some day, but not now. So diabetes never goes away. But there is hope. Not only is diabetes inherited but there are also environmental factors that enhance the genetic makeup. In Type2 diabetes the main environmental factor is insulin resistance due to obesity. Thus diet, exercise & wt. loss may make it seem like you have reversed the diabetes. You have not really. What you have done is reduce the insulin resistance & relieve the stress on the beta cells so they can do their job. If she regains the wt. though the diabetes will return in force. So it is important that she understands this & never quits her program.

The simple answer to this question is NO Concentrated SWEETS. Some Dr. restrict all carbohydrates. That is not necessary & may be harmful. In my program we try to have patients (including me) follow a sensible diet. We follow the American Heart Association sensible American Diet Plan. They developed it to prevent heart disease but since heart disease is a common complication of diabetes their diet makes sense for people with diabetes. The diet consists of about 50- 60% of the calories from complex carbohydrates, no more than 20-30% fat and no saturated fat, & the rest from protein. Avoid concentrated sweets such as candy bars, cakes & pies, etc except in small amounts on special occasions (such as a small piece cake without the icing on your birthday). Please see a dietician and remember what Saint Paul said "Be moderate in all things." That's still good advice.

The answer to this question depends on several factors such as how long after meals we are talking about. In general though we tend to measure post meal BS at 2 hours after the meal. In normal people the BS fasting is between 70-100 and post meal is between 80-125 depending on the times of measurement & what you ate. volume of food & type of food (carbohydrate will bring the BS up faster than protein or fat) ingested will have an enfluence on the post meal blood sugar. Most Dr. today say keep the post-meal BS less than 180 in people with diabetes. I have always taught my patients to keep it less than 150 & I try to keep mine less that 140. Good luck!

For this answer I would refer you to the web site of the American Diabetes Association= ADA.edu They have brochures that explain this & tables with values. Unfortunetly most prediabetes is asymptomatic & hard to detect. A fasting BS between 100 & 125 and/or a HbA1c test between 5.8-6.5 are usually considered pre diabetes.

Thyroid glands usually do not hurt. Even very enlarged glands (goiters) are usually not painful. If it is your thyroid gland that is painful, you should see your DR. A painful gland usually means sub-acute thyroiditis (usually due to a virus) or acute thyroiditis usually due to a bacterial infection. Both can & should be treated so see a Dr. right away for some tests & treatment.

See the American Diabetes Association web site for detailed info on this. The site is ADA.edu They list 9 signs of developing diabetes. These include wt. gain & obesity, if female having a baby that weighs over 9 #, a family history of diabetes, excess thirst & urination, etc. There are 2 types of diabetes Type 1 & Type 2 and the early signs are different so I would refer you to the ADA for details of each. The info from them is free.

Sometimes yes & sometimes no. The beta cells that make insulin age & deteriorate just like any other organ. Just as your joints wear out & may need replacement, as a female your ovaries wear out & you are no longer fertile, your brain can wear out & you develop dementia and just as the brakes & other parts of your car wear out so can the beta cells of the pancreas. It has been estimated that under ideal conditions that the life span of the beta cells is about 140 yrs. So if we lived to be 150 yrs old we'd all have diabetes. Sometimes the beta cells wear out faster in one person than in another. So that person will see their diabetes worsen with age while the other will not. This is controlled by both genetic causes we can do nothing about and by environmental factors such as obesity, sedentary lifestyle, failure to take medicine, etc that we can do something about. The more strain we put on the beta cells from overeating, eating the wrong things, not exercising, obesity, etc. the sooner the cells will deterioate & the diabetes will get worse. So you can do something to slow the deterioration by your life style & following the rules. I have had diabetes for 27 Yrs. & it has not gotten better or worse but I try hard to follow the rules I taught my patients over the years.

I am an endocrinologist, not a hematologist. I have never heard of this before, but any machine can go bad at times. If the machine was shaving off metal particles, they could have gotten in the blood. They would have been excreted by the kidney, though they could cause kidney damage. I would check with a kidney Dr. & have your kidneys checked. Other than that, little damage would be done & since symptoms are gone, I wouldn't do anything except find a different plasmapheresis center next time. If there is found to be any permanent damage especially to the kidneys, then I'd see a lawyer.

About anything that is low in salt. No foods seem to cause high BP in people with diabetes or in non-diabetics except those high in salt. Processed foods especially processed meats, are especially high in salt as are many snack foods such as potato chips, etc. These should be avoided whether you have diabetes or not since they can cause high BP whether you have diabetes or not. Be temparent in all things especially high salty food, check your BP often & take your BP meds if on them.

Yes you can but obey St. Paul & be moderate in all things. Pasta whether whole grain or refined flour, is a high carbohydrate food. These foods increase blood sugar & put on wt. So be moderate & wise in the amount of intake & learn how to adjust your diabetes meds to compensate for high carbs.

Whole grain bread is best. It doesn't much matter which grain it comes as long as it is whole grain & not refined flour. Whole grain breads are high in fiber that is important for regularity & fiber slows absorbtion of other carbohydrates. Thus the fiber of whole grain breads will help you with diabetic control.

Fasting blood sugar in the morning in most people without diabetes is between 70 & 100. After meals it may go up to 125 in non-diabetics-AM, PM or evening. So BS in the evening after supper should be between 100 & 125. It gradually falls lower during the late eve or night so the fasting in the morning is lower. You did not say why your sons BS is low. I assume from this he does not have diabetes. If he does, the low BS is easy to fix-simply decrease his diabetes meds, If he does not have diabetes, but has hypoglycemia he needs a work up to find out why. This can be due to a problem of the liver, a tumor of the beta cells of the pancreas, a failure of the beta cells of the pancreas to communicate & coordinate insulin secretion, failure of the pancreas to produce glucagon (a hormone that raises BS) or a failure of the liver to respond to glucagon & release stored sugar. He needs to see a Dr. familiar with hypoglycemia & find out the cause of his hypoglycemia since most causes are treatable & continued hypoglycemia can cause brain damage.

People with diabetes tolerate pain meds about the same as people who do not have diabetes so any pain reliever is probably all right. All of them have some kind of side effects. Asparin is the most commonly used but it can cause gastro-intestinal bleeding and in small children, a form of heart disease. At 18 the latter probably will not occur. Acetominophen works well & has few side effects though it can cause liver or kidney damage if taken long term & high doses. There are many NSAID medications on the market & they work well with few side effects though like any drug they can have some I some people. A NSAID such as "Aleve" or others would be my first choice for him. Stay away from addicting pain relievers such as oxycontin & similar drugs as they are highly addicting. A simple pain reliever such as asparin, acetomeniphen (Tylenol) or NSAID would be best.

Any of the artificial sweeteners are OK. you will see a lot of derogatory comment about artificial sweeteners but most of this is urban myth or propaganda from the sugar industry. The latest myth is that they will stimulate appetite & cause you to eat more & become fat. There are no good well controlled studies to back up such a claim. It makes about as much sense as the claim a few yrs. ago that Gulf War disease was caused by our soldiers drinking artificially sweetened soda-pop in the desert. Well here are the facts-soldiers in battle don't drink any kind of soda. With or without sugar or artificial sweetener, drinks that get hot in the desert taste awful so no one would drink them. Also the Army provides water trucks for the soldiers to use to fill canteens so there is no need to drink soda whether it contains sugar or AS. There are several kinds of AS on the market now & all are safe. Try them & see which ones you like best & stick to it or them.

The answer to that is simple-any person with diabetes (Type1 or type2) who stops their meds will have a high blood sugar. If this happens often or they stop entirely, then expect high blood sugars & a high HbA1c & in the long term, damage to the blood vessels & nerves resulting in blindness, kidney failure, neuropathy, brain damage & heart disease. Take the meds, check the blood sugar frequently and check HbA1c at least every 3-4 mo. Keep the A1c below 7 & preferably below 6.5%. & he can avoid the complications.

NO. Brown sugar is still sugar & provides the same calories & elevation of BS as white sugar. Sugar is sugar whether white (refined) or brown (unrefined or malted). Artificial sweeteners are safe & most are tasty. Stick with them & avoid any form of sugar.