DEAR DR. DONOHUE: My wife has type 2 diabetes and takes oral medicine for it. I was just told I have type 1. How is that possible? Isn’t type 1 something kids get? I am 52. How did this happen? I have to take insulin. Is there any chance I could take pills someday? – R.M.

ANSWER:
With both types of diabetes, 1 and 2, blood sugar is above the normal value. And the symptoms of high blood sugar are the same – frequent urination of large volumes, thirst and a huge appetite without weight gain. The similarities end there.

Type 1 diabetes used to be called “juvenile diabetes” because it’s the kind more common in childhood. But age is not the determinant. This kind of diabetes results from an immune attack on the insulin-making cells of the pancreas. Insulin levels are so low that they cannot keep blood sugar controlled. Insulin shots are its treatment.

Type 2 diabetes comes about from the body’s sluggish response to insulin. Type 2 diabetics, at least in the early stages, produce enough insulin, but the insulin cannot get sugar to pass into cells like it should. Type 2 diabetes is the more common kind of diabetes, affecting 90 percent of all diabetics. Oral medicines and diet often can control type 2. However, some type 2 patients do need to take insulin.

You are not likely to ever come off insulin. Your insulin production is too low and will remain too low until medicine finds out how to stimulate insulin-making cells to rejuvenate.

That day might not be so far off. Great advances have been made in delivering insulin in ways other than shots, and advances have been made in transplanting the pancreatic cells that make this hormone.

DEAR DR. DONOHUE: My husband saved my life, and I want everyone to know how he did it. I woke up one morning unable to catch my breath. I thought I might have caught something during the night and that this would be a passing thing. It wasn’t. My husband insisted on calling 911 even though I tried to discourage him. I was taken to the emergency room, where I had a cardiac arrest. I was revived and was told my heart had stopped beating because I had a large heart attack. The doctor told me I never would have survived if I hadn’t been brought to the ER. I did not have any chest pain. People should know that you can have a heart attack without having chest pain. – W.P.

ANSWER:
Not all heart attacks come with severe, crushing or squeezing chest pain felt in the center or slightly to the left of the chest. Classically, the pain might radiate to the neck, the left shoulder or the left arm. Many heart attacks, however, have different symptoms.

As many as one-third of heart-attack victims have no chest pain. Such people might feel very short of breath, as you did. Or they might complain of overwhelming fatigue — not sleepiness, but a profound weakness that makes it hard to hold the head erect. Or they might have pain only in the neck or jaw. Some have upper abdominal pain that they mistake for indigestion.

Any of the above symptoms, when prolonged, should suggest a heart attack, and the path your husband took for you should be taken for all people with similar complaints.

Heart attacks are common and confusing. The heart-attack booklet describes what happens and how to treat it. Readers can obtain a copy by writing: Dr. Donohue – No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am pregnant with our seventh child. We cannot afford any more children, so I am going to have a tubal ligation after delivery. A friend says that tubal ligations mess up normal menstrual periods. Is that the case? – B.B.

ANSWER:
At one time, there was a belief that tubal ligations caused something called post-tubal ligation syndrome. Large studies have debunked that idea. Few, if any, subscribe to it these days.

DEAR DR. DONOHUE: What can you tell me about the metabolic syndrome? I have it but I don’t know much about it. My doctor has painted a grim picture of what’s going to happen to me, but he hasn’t given me any instructions on what to do for it other than to lose weight. What else can I do? – P.P.

ANSWER:
The metabolic syndrome – something you have in common with many, many other people – consists of a number of physical and laboratory abnormalities that, if not reversed, lead to heart disease, stroke or diabetes.

Obesity with a large abdomen is one of those abnormalities. Women with a waist that measures more than 35 inches (88 cm) and men with a waist greater than 40 inches (102 cm) fit one of the criteria for metabolic syndrome. Abdominal fat produces many endocrinelike substances with deleterious health consequences. Losing 3 percent to 10 percent of current body weight can undo this metabolic syndrome feature.

Blood triglycerides greater than 150 mg/dL (1.7 mmol/L) is another mark of this syndrome. You lower triglycerides by reducing your fat intake (meat, whole-fat dairy products, fried foods) and your carbohydrate intake, particularly those carbohydrates that raise blood sugar quickly (table sugar, potatoes, pancakes, doughnuts, cookies, bagels, white bread and many cold cereals).

Men with an HDL cholesterol lower than 40 (1 mmol/L) and women with an HDL cholesterol lower than 50 (1.3 mmol/L) fill another metabolic syndrome marker. HDL cholesterol is good cholesterol, the kind that removes cholesterol from artery walls. Daily aerobic exercise like brisk walking increases HDL cholesterol.

Blood pressure equal to or higher than 130/85 is another metabolic syndrome criterion. Weight loss, daily exercise and cutting way back on salt lower blood pressure.

A fasting blood sugar (plasma glucose) higher than 100 mg/dL (5.6 mmol/L) is the final element of metabolic syndrome. Again, weight reduction and daily exercise can correct this problem.

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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