Diabetes

How does weight loss help control Type 2 diabetes?

DEAR DOCTOR K: I was recently diagnosed with Type 2 diabetes. My doctor said the best thing I can do right now is to lose weight. Why?

DEAR READER: Type 2 diabetes usually starts after a person becomes an adult. It is by far the most common type of diabetes. It has been clear for many years that people who are overweight are at much greater risk for developing Type 2 diabetes. In the past 20 years, research discoveries have begun to explain why.

Is “lower is better” the right approach when treating high blood sugar in someone with diabetes?

DEAR DOCTOR K: In a recent column you said that doctors are not trying to lower blood sugar as much as they used to in people with diabetes. My husband's doctor always tells him that "lower is better" when it comes to his blood sugar. Can you explain?

DEAR READER: When I was in medical school, and for many years thereafter, "lower is better" was what doctors believed. We knew that people with diabetes could develop severe, even fatal, complications if their blood sugar got very high. Plus, we had powerful blood-sugar-lowering treatments available.

Does prediabetes put me on an irreversible path to Type 2 diabetes?

DEAR DOCTOR K: After years of normal blood sugar levels, I'm suddenly in the prediabetes range. Am I on an irreversible path to Type 2 (adult-onset) diabetes?

DEAR READER: No, you're not, but you're facing a challenge. Prediabetes is an early warning signal: You are at higher risk for developing diabetes. But diabetes is not inevitable. In fact, we know more about how to reduce the risk of getting Type 2 diabetes than we know about preventing most other major diseases. There are several things you can do to reverse course.

How does diabetes affect vision?

DEAR DOCTOR K: I was recently diagnosed with Type 2 diabetes. Can you explain how diabetes affects vision?

DEAR READER: Both of the common types of diabetes, Type 1 (which usually begins in childhood) and Type 2 (which usually begins in adulthood), can affect vision in several ways. After 20 years of having Type 2 diabetes, most people have eye problems. But the risk can be reduced, as I'll explain.

Why does diabetes and high blood pressure increase my risk for kidney disease?

DEAR DOCTOR K: I have high blood pressure and diabetes. I was surprised to learn that they increase my risk of kidney disease. How do they do that?

DEAR READER: Many people know that high blood pressure and diabetes increase the risk of getting heart disease. But less well known is the fact that they are also powerful risk factors for kidney disease. The kidneys filter toxins and wastes from the bloodstream, flushing them out of the body in urine. At the same time, they hold on to important proteins and other useful substances. This process helps control levels of fluid, salt and acid in the body. The kidneys also play an important role in regulating blood pressure.

What is metabolic syndrome?

DEAR DOCTOR K: My doctor says I have metabolic syndrome. He said it's "like diabetes but not diabetes," which I don't understand. Can you explain what it is, and how I can fix it?

DEAR READER: Metabolic syndrome is quite common, but not very well known. Many of my patients have it; nearly 50 million Americans have it -- and many of them don't know it. Metabolic syndrome is dangerous. If you have it, you have a much higher risk of several major health conditions. Recent studies find that your risk of developing diabetes is four to five times higher. I guess that's what your doctor meant when he said it was "like diabetes but not diabetes." Your risk of stroke or a heart attack is about double. Your risk of dying prematurely is 30 to 60 percent higher.

Can you explain what a low glycemic index diet is?

DEAR DOCTOR K: Diabetes runs in my family, and my mother says I should eat a "low glycemic index" diet. Can you explain what this is?

DEAR READER: Carbohydrates ("carbs," for short) are one of the main types of nutrients in food. Common sources of carbs include bread, pasta, cereals, fruit, milk, vegetables and beans. The carbs we eat are mostly too big for us to digest. Carbs are long strings of a certain type of molecule. Think of them as a string of pearls. When they hit the gut, digestive enzymes start to chop them up. It is the one-pearl and two-pearl strings that are the sugars that get digested and travel from the gut into the blood.

I have Type 2 diabetes, how can I achieve a healthy pregnancy?

DEAR DOCTOR K: I have Type 2 diabetes, and I would like to get pregnant. What can I do to increase my chances of having a healthy baby?

DEAR READER: Like you, some women already have either Type 1 or Type 2 diabetes before they become pregnant. There also is a kind of temporary diabetes that develops during pregnancy called gestational diabetes. It goes away after the baby is born. You're right to be concerned. Type 1, Type 2 and gestational diabetes all cause high blood sugar and can cause pregnancy complications. But for this column, I'll focus on pregnancy and Type 2 diabetes.

Is tight blood sugar control right for all type 2 diabetics?

DEAR DOCTOR K: I have Type 2 diabetes. For years, my doctor emphasized the importance of tight blood sugar control. But I recently read that tight control might not make sense for everyone. Why not?

DEAR READER: Millions of people with diabetes, and their doctors, are asking themselves the same question. It's a confusing and controversial area. I'll do my best to put it in context and to explain my own views. People with Type 2 diabetes have high levels of blood sugar if they don't take medication that lowers their blood sugar level.

How do I protect myself against diabetic ketoacidosis?

DEAR DOCTOR K: I have had Type 1 diabetes for 20 years. I'm worried I may get ketoacidosis, even though I never have. How do I protect myself?

DEAR READER: You are at risk for ketoacidosis, but the fact that you've never had it is encouraging. It means you're already doing the things you need to do to prevent it. That's important, because diabetic ketoacidosis is a serious complication of Type 1 diabetes. Let's start with a few basics. Type 1 diabetes is often called "insulin-requiring" diabetes.