DEAR DR. DONOHUE: Three or four weeks ago I was diagnosed as having diabetes. I take one glyburide tablet a day. I check my blood sugar level, and it is always good. I am watching my diet and have taken off 12 pounds. I have read that this medicine can possibly cause cardiovascular disease. Is that so? – P.D.

ANSWER:
Some background information is necessary to understand why there once was a reputed connection between heart troubles and diabetes medication.

Glyburide (DiaBeta, among other brand names) is an oral diabetes medicine that stimulates the pancreas to release more insulin – the hormone that regulates blood sugar.

In 1970, a study (the University Group Diabetes Program study) threw everyone into a tizzy because it purported to show that a diabetes drug of the same family as glyburide caused users to have more heart attacks than did diabetics who controlled their blood sugar by strictly adhering to a diet or by taking insulin.

Quite naturally, this was upsetting, as these oral medicines were used by millions of people. From the time of the publication of that article until a short time ago, proponents of the study fought with others who felt that the study was erroneously conducted.

In 1998, the debate ended. A new study (the United Kingdom Prospective Diabetes Study) showed no link between oral diabetes medicine and heart attacks.

You can use this medicine without worry.

The incidence of diabetes is increasing, but many are still in the dark about it and its treatment. The diabetes pamphlet can shed light on this subject. Readers can order a copy by writing: Dr. Donohue – No. 402, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am 67 years old, 6 feet tall and weigh 160 pounds. My blood sugar after fasting overnight is 104 mg/dL (5.7 mmol/L) and my Hb A-1c, 6.5 percent. Do I have diabetes? Do I have prediabetes? I am confused. Should I start treatment with drugs? – J.S.

ANSWER:
Doctors make a diagnosis of diabetes when the fasting blood sugar is 110 (6.1) or higher. You are as close to perfection as any human ever comes.

Fasting blood sugar levels of 110 (6.1) but less than 126 (7.0) fall into a zone called impaired glucose tolerance. They do not indicate diabetes, but they do sound an alarm. A substantial number of people with such readings will go on to have overt diabetes unless they make drastic changes in their lives. They must lose weight, exercise more and eat a diet in which vegetables, fruits and grains are the main constituents.

The Hb A-1c blood test gives doctors a good idea of what a patient’s blood sugar averaged in the past two months. It is primarily used to check blood sugar control rather than to confirm a diagnosis of diabetes. A value less than 7 percent tells the doctor that the patient has been in good control for the past two months.

You do not have diabetes. You do not have prediabetes. You do not have impaired glucose tolerance.

Sleep in peace.

DEAR DR. DONOHUE: I have a Web site for you and your readers who want to know what to do with one unneeded shoe. If people go on the Internet and locate the Web site www.nationaloddshoeexchange.org, they will obtain information on where to send the extra shoe. – H.

ANSWER:
A nun who had lost one leg wanted to know where she could send the shoe she had no need of. She and many others will be overjoyed at finding a clearing house that can put these shoes to use.

Want to know who H is? It’s none other than Heloise of the syndicated column Hints from Heloise. She has provided me with useful information in the past in her column and now is kind enough to provide this information. Not only does she write a column with clarity and practical information, she also happens to be one of the world’s nicest citizens. Thanks, Heloise.

DEAR DR. DONOHUE: I have recently learned that I have psoriasis. I am not clear on exactly what it is. My doctor says I’ll have to try different medicines to see what works best for me. That is not at all reassuring. What treatment do you recommend? – C.B.

ANSWER:
New skin cells arise at the skin’s deepest layer, and they take a month to reach the skin surface as fully mature skin cells. With psoriasis, the new skin cells dash pell-mell to the skin surface in a matter of days. They can’t function as well as fully mature skin cells can, and they have a different appearance from mature skin cells. A patch of psoriasis skin cells is red, raised and covered with flaky, silvery scales.

Undoubtedly a large number of as-yet-unknown factors cause psoriasis, but genes are definitely involved. Half of all psoriasis patients can point to a relative who also has it.

Psoriasis patches most often appear on the elbows, the knees, the lower back, the groin and the scalp. No place, however, is immune.

I cannot do any better than your doctor when it comes to picking the best treatment. Trial and success determine the best treatment for each individual.

Sunlight can heal psoriasis, but sunburn is harmful. Dermatologists often expose patients to ultraviolet light, and the combination of ultraviolet light with psoralen drugs frequently proves helpful.

Listing the number of ointments, creams and oral medicines would only serve to bewilder you. Knowing that there is a large number of creams, ointments, salves and oral medicines should provide you with hope, since one of them is bound to be the answer to your particular circumstances.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.


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