DEAR DR. DONOHUE: After years of having good results of lab work, including blood sugar, my new doctor tells me my C peptide is high, and so is my insulin level. My fasting blood sugar is 100 (5.6). She says my pancreas is overworking, and that makes me a type 2 diabetic. She has me on diabetes medicine.

What is this C peptide number? Do I really need medicine? – T.A.

ANSWER: The American Diabetes Association says that the fasting plasma glucose (sugar) is the criterion to judge if a person has diabetes. Fasting requires eight hours of not having any calories. A fasting plasma glucose below 100 mg/dL (5.6 mmol/L) is normal. A value of 126 or higher constitutes diabetes. Numbers between those two points are called impaired fasting glucose – prediabetes. All abnormal blood glucose tests should be repeated.

If you want to be very strict about things, you might qualify as having prediabetes. People in this group are at risk of becoming true diabetics. To prevent such progression, these people need to lose weight and become physically active. Your doctor is on the cutting edge. She uses tests not routinely done by most doctors. C peptide is a small protein associated with insulin. High levels of it indicate an overproduction of insulin. High levels of insulin indicate the same thing. An overproduction of insulin is evidence that your insulin isn’t working properly. You need more than the regular amount to keep your blood sugar low. An insensitivity to insulin is a hallmark of type 2 diabetes.

You don’t have diabetes. You might have impaired fasting glucose. Only a few doctors prescribe medicine for people like you.

Why not talk this matter over with your doctor? Tell her that you don’t relish taking medicines but that you will cut back on your calories and increase your physical activity, then have your sugar rechecked in a month or so.

DEAR DR. DONOHUE: In the past month, my urine has become cloudy. There is a sensation during urination, but it doesn’t burn. My doctor gave up his medical practice, and I haven’t looked for a replacement yet, so I’m hoping things will clear up on their own. Can you give me some perspective on cloudy urine? I’m looking for some new-fashioned advice for an old-fashioned person. I am 76. – W.D.

ANSWER: Cloudy urine doesn’t always mean infection. Two mineral materials cloud urine — phosphates and urates. If you add some vinegar to a sample of your cloudy urine and it clears right away, that indicates your urine is full of phosphates. If you heat a sample of your urine to 140 F (60 C) and it clears, that indicates urates.

Bladder infections most often cause pain on urination (burning), increased frequency of urination and nighttime urination.

Why are you dragging your feet about finding a new doctor? Your former doctor must have suggested someone to his patients. You’re 76. Bad things can start to happen around this age.

DEAR DR. DONOHUE: Both my arms feel like they’re on fire. I wake up free of pain but, as the day progresses, they start to hurt again. This started when my doctor changed my blood pressure medicine from Tenormin to Hyzaar. A dermatologist told me the medicine caused the change. I told my doctor, and she changed me to Cozaar. Still no luck. I have changed doctors, and the new one says the pain comes from neck arthritis and wants me to have an MRI scan to see if I need surgery. I didn’t have the MRI because I don’t want surgery. What do you think? It’s been a year since all this started. – V.M.

ANSWER: Hyzaar contains losartan and hydrochlorothiazide, a diuretic. Cozaar is only losartan. If medicine caused your pain, losartan is the likely culprit. It can cause peculiar sensations, and it can cause nerve damage, which can give rise to pain. Those side effects are extremely uncommon, and they should have resolved after a full year without taking losartan.

Why not resolve the question of arthritis-caused pain by having the MRI? Even if you don’t want surgery, the scan could possibly identify the cause of your pain and there might well be effective treatments other than surgery.

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