DEAR DR. DONOHUE: I am an 85-year-old woman. My primary care doctor periodically orders blood work for me (copies are enclosed, along with a list of my medicines). He noted an increase in my blood sugar and cholesterol and asked about any changes in my eating. During the past nine months, my weight has come down about 15 pounds. I eat less fat and fewer carbs. I will have another lab check. Your opinion on the cause of these rises would be appreciated. – M.V.

ANSWER:
Fasting blood-sugar readings between 100 to 125 mg/dL (5.55 to 6.9 mmol/dL) are in a category called prediabetes. One of your readings falls into this category, and the other is just outside it. People with prediabetes are on a road that leads to diabetes. You’re doing all the right things. You’ve lost weight, and you watch what you eat. The explanations why your second reading is slightly higher than the first are many. Did you fast for eight hours before your blood was drawn? Was the second blood drawn at the same time as the first? I see on your medicine list that you take glucosamine for arthritis. Glucosamine can raise blood sugar. Before your next test, stop taking it for a week to see if it contributes to the slight rise in your sugar. Your hemoglobin A1c is 6 percent, a normal reading. HbA1c indicates what your blood sugars averaged in the past three to four months. Slightly high blood-sugar readings in the face of normal HbA1c don’t prove diabetes.

Now for cholesterol. Total cholesterol should be under 200 mg/dL (5.17 mmol/L). Your first reading was 223, and your second was 250. You are 85. If your doctor doesn’t put you at high risk of having a heart attack, at your age, you don’t have to pay so much attention to cholesterol. Putting you on yet another medicine might harm you. It’s better to treat the patient than the patient’s lab values. On the other hand, if you are at high risk for a heart attack, taking cholesterol-lowering medicine would be something to consider.

The diabetes booklet explains this common condition in detail. 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 $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a 36-year-old man with discoid lupus. I was prescribed Plaquenil, which made me ill and did me no good. Tell me how I can get rid of these hideous patches on my head and face. – F.V.

ANSWER:
“Discoid” means “disk-shaped,” and that’s the configuration of skin patches affected by discoid lupus. They’re circular, red and a little raised, with a thick scale stuck to the surface. Long-standing patches lose color, but the edges remain red and slightly elevated and their centers thin. The scalp, face and ears are targets of discoid lupus. On the scalp, involved patches often lose their hair.

Discoid lupus, unlike the more common systemic lupus, almost always stays localized to the skin and does not affect joints, kidneys, heart, lungs and brain.

Never go outside without putting on sunscreen with an SPF of at least 15. Plaquenil is a frequently prescribed drug, but if you can’t use it, then try prescription cortisone ointments or creams. If they don’t turn things around, cortisone medicines can be injected directly into the affected patches.

DEAR DR. DONOHUE: As I have grown older, I find that I stand and walk hunched over. I am active and work out with weight machines and perform aerobics. I found the enclosed ad that intimates the shoes they advertise will improve posture. Is it possible to do so with shoes? – D.O.

ANSWER:
I don’t know for sure. I see how they give your body a different center of gravity, and that could adjust your posture. Try them on in the store and see what they do before buying them.

One cause of becoming hunched over with age is osteoporosis, which affects men as well as women. Calcium, vitamin D and perhaps osteoporosis medicine might help if that’s the case. Continue your exercise program. Few things benefit bones as much as exercise.

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. Readers may also order health newsletters from www.rbmamall.com.


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