expert type icon EXPERT

Dr. Richard A. Guthrie, M.D.

Endocrinology-Diabetes

Dr. Richard Guthrie practices Endocrinology in Wichita, KS. Dr. Guthrie specializes in preventing, diagnosing, and treating diseases related to hormone imbalance, and the bodys glands in the endocrine system. Endocrinologists are trained and certified to treat a variety of conditions, including menopause, diabetes, infertility, and thyroid disorders, among many others. Dr. Guthrie examines patients, determines means of testing, diagnoses, and decides the best treatment methods.
59 years Experience
Dr. Richard A. Guthrie, M.D.
  • Mount Hope, 20
  • Univ of Mo, Columbia Sch of Med, Columbia Mo
  • Accepting new patients

What should be the emergency first steps to deal with hypoglycemia in diabetic patients?

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 READ MORE
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.

Can type 2 diabetes ever be reversed?

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 READ MORE
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.

Can beetroots be harmful for a diabetic patient?

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 READ MORE
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.

Is vitamin D deficiency normal in diabetes patients?

Probably not. Some studies have indicated some relation between diabetes & Via. D def. but more as def. a cause of diabetes. Other studies have shown no relationship. Vitamin D READ MORE
Probably not. Some studies have indicated some relation between diabetes & Via. D def. but more as def. a cause of diabetes. Other studies have shown no relationship. Vitamin D def. is more likely due to too little enriched dairy products &/or to little sunshine. More of these could solve the problem or oral Vit. D supplements should correct.

With a family history of type 2 diabetes, is my daughter at a risk of juvenile diabetes?

Diabetes is inherited via recessive genes so she must get a gene from each parent. So diabetes in one side of the family and not in the other does not increase the chance of diabetes. READ MORE
Diabetes is inherited via recessive genes so she must get a gene from each parent. So diabetes in one side of the family and not in the other does not increase the chance of diabetes. So if dad has diabetes or is a carrier of the gene, he could pass that gene on to the child but if chid gets a normal gene from you, the child is a carrier but should not have diabetes. The problem is are you a carrier? If so the child COULD get diabetes. For those having the genes, there are environmental factors that can influence development of he disease. For Type 1 DM, viral infections & other as yet unidentified factors may influence development. For Type 2 DM diet & wt control are important. So do watch diet & limit sweets. We all have a sweet tooth we must control as this may cause other problems as well (tooth decay, etc.) So watch that & do not let the child become obese as that increases chance of diabetes, heart disease & some cancers.

If I have diabetes during pregnancy, what are the chances of my child getting it too?

These are good questions some of which are under study & we do not have answers yet. Since you have gestational diabetes, you are carrying the diabetes genes & will pass that on READ MORE
These are good questions some of which are under study & we do not have answers yet. Since you have gestational diabetes, you are carrying the diabetes genes & will pass that on to the child. It takes a gene from both parents though for the child to have diabetes. So the problem is does your spouse carry the gene. We don't know the genes for diabetes especially Type 2, so we can't test him. How well you manage the diabetes during the pregnancy probably has little effect on whether the child will develop diabetes but poor control will have other adverse effects such as big babies with difficult delivery, post delivery hypoglycemia & hypocalcemia, jaundice & other problems in the baby. So control your blood sugar well during the pregnancy and don't worry about the future.

When are insulin injections recommended for patients?

Don't worry about insulin injections. I have taken them for 25 yrs & it's no big deal with modern pens, small needles, and other equipment. The American Diabetes Association, the READ MORE
Don't worry about insulin injections. I have taken them for 25 yrs & it's no big deal with modern pens, small needles, and other equipment. The American Diabetes Association, the American Association of Clinical Endocrinologist, & other organizations have produced guidelines that say start insulin at Hba1c of 9% or above.

How can I manage insulin for my mother who is 80 years old?

To answer this, I would need more information. What is the level of self-care your mother is capable of? Does she live with you or are you close? How is her eyesight, dexterity, READ MORE
To answer this, I would need more information. What is the level of self-care your mother is capable of? Does she live with you or are you close? How is her eyesight, dexterity, her mind, etc.? In general, pens can help, pre-drawing a week's doses of insulin, setting clocks for reminders, visiting nurses, etc., can help. I can't give specifics for her without the above information.

Is Stevia okay for diabetics?

Stevia is an extract from a plant grown in Africa (although can be grown in your own garden). It has been used in Africa for hundreds of years and has no known bad effects. There READ MORE
Stevia is an extract from a plant grown in Africa (although can be grown in your own garden). It has been used in Africa for hundreds of years and has no known bad effects. There are always articles appearing in the literature to debase artificial sweeteners. You need to know the source of this literature. There are no good scientific studies to say that any of the artificial sweeteners, including Stevia are harmful. If there was evidence that they were harmful, the FDA would pull them from the market. Brown sugar is unrefined sugar and is no different in its effects in people with diabetes than white sugar. It should be avoided just as white or refined sugar. The problem with any sugar is that they are empty calories and are quickly absorbed so give a rapid rise in blood glucose. They are OK to treat low sugar, but not good for everyday control or wt. maintenance.

What is the difference between Type 1 and Type 2 diabetes?

Type 1 diabetes is the more serious disease and occurs most often in younger people such as children. It can occur in adults. My mother was in her 50's, as was I, when we developed READ MORE
Type 1 diabetes is the more serious disease and occurs most often in younger people such as children. It can occur in adults. My mother was in her 50's, as was I, when we developed Type 1 diabetes. The definition of this disease is the lack of insulin secretion. So these people have damage from the immune system that destroys their insulin producing cells (beta cells) in the pancreas and thus are dependent on insulin from the outside to live.
Type 2 diabetes is a different disease. It begins with the bodies resistance to insulin and an increase not a decrease in blood insulin levels. Later the pancreas may wear down from the need for hyper secretion of insulin & go into failure. The patient may then need insulin to control blood glucose but is not dependent upon it to live. This disease occurs mostly in adults but there is an increasing incidence in children with the epidemic of obesity (which causes insulin resistance) in children. I have treated a 4 yr. old child with Type 2 diabetes. The genetic background which interacts with environmental factors to cause these two diseases are different as are the environmental factors. Type 2 diabetes is usually associated with obesity while people with Type 1 are usually slender & have lost wt. prior to diagnosis. There is overlap in these 2 diseases, however, with some children with Type 1 getting overwt. & developing simultaneous Type 2 -- what is now called Double diabetes. Type 2 patients can also lose all their insulin producing ability & be dependent on insulin for life. It is like 2 roads that may eventually come together to produce the same symptoms, but how you got there was different.

My HbA1C reports have reduced from 7 to 4.2. Does it mean I'm no longer at risk for diabetes?

No it does not. What it means is that you have been good & gotten the diabetes under control. Diabetes is a genetic disease we get from our parents & we cannot change our genetics. READ MORE
No it does not. What it means is that you have been good & gotten the diabetes under control. Diabetes is a genetic disease we get from our parents & we cannot change our genetics. We can control circumstances & life style & make it better. You have done that well & should complement yourself. You still have diabetes but it under control. Lapse into overeating, under exercising, wt. gain & obesity and you will see your diabetes come back & HbA1c go up. Congrats. on what you have achieved.

In spite of Glycomet medication, my weight is constantly increasing. What should I do?

What should you do to lose wt.? Simple decrease your food intake & increase your calorie burning (exercise). Never depend on medications to lose wt. They are a help but life style READ MORE
What should you do to lose wt.? Simple decrease your food intake & increase your calorie burning (exercise). Never depend on medications to lose wt. They are a help but life style change is more effective. Remember Newton's law of thermodynamics: Energy is neither increased or decreased in the universe, it is only changed from one form into another. So if you consume more energy (food) than you expend for energy (activity & exercise) the excess energy consumed is converted to another for (fat). To get rid of the fat you must burn more energy (exercise) than you consume (food). Medications are a help but cannot do the job without your help. The medications just help you not want as many calories, they do not help you burn calories. Consult a dietician & an exercise specialist to help you outline a good program that fits your capabilities.

What should the diet of a diabetic patient ideally include?

Diet in persons with diabetes is a complicated & much discussed issue. It is too complex to discuss here. Also without more information, it would be impossible to give much more READ MORE
Diet in persons with diabetes is a complicated & much discussed issue. It is too complex to discuss here. Also without more information, it would be impossible to give much more advice. The elevated creatinine indicates she has kidney disease & that would influence the diet. She should see a dietician who is knowledgeable in diets for diabetes & in renal disease diets and a physician to control her diabetes & renal disease.

I have repeated urine infections. I'm also diabetic. What can the cause be?

To answer this question I would need more information. How well is the diabetes controlled? Have you seen a urologist? There are many causes of recurrent UTI. See a urologist to READ MORE
To answer this question I would need more information. How well is the diabetes controlled? Have you seen a urologist? There are many causes of recurrent UTI. See a urologist to be sure there is no anatomical problem with the urinary tract (polyps, etc.). Other causes are sexual trauma, etc. All these causes can be corrected. As for diabetes, high sugar content of the urine can lead to UTI as can partial paralysis of the bladder from diabetic neuropathy. Again, a urologist can test for urinary retention. As to the diabetes, be sure to be in control so there is minimal sugar in the urine. Luraglitide and metformin are good treatment. The glicticide is a sulphonylurea drug that is "out of style" today because of hypoglycemia and wt. gain. You should not take a drug of the SGLT2 class since these drugs increase the sugar in the urine. If your diabetes is not in good control, I would recommend starting a GLP2 RA or insulin to get optimal control and keep sugar out of the urine.

Why am I not putting on weight?

With the small amount of information you sent, is impossible to say why this is happening. I would need to know things like your age, degree of diabetic control, meds you are taking, READ MORE
With the small amount of information you sent, is impossible to say why this is happening. I would need to know things like your age, degree of diabetic control, meds you are taking, etc. including what type of diabetes you have. If you still have high blood sugars then you are not putting the carbohydrate into the cells but losing the calories in the urine. So get the blood sugars under control & see a dietician to get a good diety plan.

My mother suffered from 3 episodes of hypoglycemia in a day. Will she be okay?

This question is hard to answer without knowing something about her level of control, drugs she is on, general state of health, etc. I would also need to know how low the blood READ MORE
This question is hard to answer without knowing something about her level of control, drugs she is on, general state of health, etc. I would also need to know how low the blood sugar was. In general. most hypoglycemia does little or no permanent damage but severe lows can cause brain damage & should be avoided at all costs especially in the very young and the elderly. If this is a recurrent problem she should see her physician and get her medication adjusted. It is also important to look at other reasons for the lows. Over 90% of lows are not due to the wrong meds or the wrong doses but due to errors by the patient such as timing of meds, med errors, not matching food, exercise & meds, etc. This should be looked into & be sure she has received the proper & completer education in self care.

Are my insulin injections permanent?

You may not need insulin injections forever. I assume you have type 2 diabetes and are not now taking insulin. With time though your pancreas loses its ability to make insulin READ MORE
You may not need insulin injections forever. I assume you have type 2 diabetes and are not now taking insulin. With time though your pancreas loses its ability to make insulin in spite of what drugs you are taking to help. Insulin then may be needed. Blood sugar must be controlled to prevent serious complications. If that requires insulin, don't hesitate to take it. Its not so bad. I have taken it for 25 years. If you are overweight that creates insulin resistance and creates the need to take insulin. If you lose weight, your insulin resistance goes down and you might come off insulin. There are several insulin regimes you could tray y such as a very long acting insulin combined with a GLP1 RA in one shot/d instead of 2.

Can I take Insulin to control blood sugar?

It is difficult to answer this without more information. What medicine are you taking now, dosage, timing, etc., and what are your other blood sugar values? You gave only after READ MORE
It is difficult to answer this without more information. What medicine are you taking now, dosage, timing, etc., and what are your other blood sugar values? You gave only after lunch. Here is a general answer only: Blood sugars need to be controlled and there is no value at which you start a given drug. 280 after lunch is way too high and something should be done to bring it down. If that something is insulin, then so be it. Fasting blood glucose should be below 110 and never over 120. After meals should be below 140 and never exceeding 180. What is your HbA1c? It should be below 7%. If not at these levels and are on several oral agents at max doses, the insulin is needed. With this high of a post meal BS, I would go to a 4 dose insulin schedule of a long acting insulin at bed time and a short acting insulin with each meal and stop all oral agents except metformin.

diabetes mellitus

First of all 8000 mg metformin/d exceeds the max dose level recommended which is 2500 mg/d. 2nd Sitigliptin is not a very effective drug. Most oral agents will lower the HbA1c READ MORE
First of all 8000 mg metformin/d exceeds the max dose level recommended which is 2500 mg/d. 2nd Sitigliptin is not a very effective drug. Most oral agents will lower the HbA1c by about 2 points. Sitagliptin lowers it by 0.3-0.5%. For you I would 1) lower the metformin to 1000 mg 2x/d 2) check kidney function-at your age & dose of metformin you better have good kidney function as you are at risk of lactic acidosis. 3) I would stop the sitagliptin and go to a stronger agent. This could be an SGLT2 drug and/or a GLP1-RA drug of which there are many on the market-some you take daily & some weekly by injection. Finally if none of this works there is always insulin. It always works though you & your Dr need to know about the different insulins & how to use them.

Why does my mother have fluctuating diabetes levels?

It is impossible to answer this question without more information. There are many reasons for wide fluctuations of BG. She may be on the wrong medicine, or the wrong doses, or READ MORE
It is impossible to answer this question without more information. There are many reasons for wide fluctuations of BG. She may be on the wrong medicine, or the wrong doses, or she may not be getting the medicines at the right time to coincide with the food or activity. Without knowing what medicine or medicines she is on & doses & timing between meds & food & her activity patterns and most important the pattern of her BG over several days or weeks, I cannot give you a better answer. Talk to her physician. Take him or her at least 2 weeks of BG measures done 4x/d and look for patterns that may show the cause.