DEAR DR. DONOHUE: My husband has had diabetes for five years. He took it seriously, lost weight and followed his diet. He was on oral medicines, and his diabetes was well controlled, according to his doctor. However, something happened in the past four months. His sugars have been quite high, and his doctor put him on insulin.

A week ago, he had a serious reaction to insulin. It happened around 3 in the afternoon. I couldn’t understand what he was saying, and he was quite unsteady and sweating. I gave him orange juice, and he pulled out of it. What’s the best way to handle this situation? I was scared out of my mind. — S.L.

ANSWER: An insulin reaction is a scary event. You have to stay calm and have a plan for how to deal with it firmly in mind.

Your husband has type 2 diabetes, the kind that comes on at older ages and is usually controlled without insulin. Having said that, I have to admit that quite a few type 2 diabetics eventually must use insulin to keep their blood sugar controlled. The goals of control are a blood sugar (plasma glucose) of 70 to 130 mg/dL (3.9 to 7.2 mmol/L) after an overnight fast. The ideal is 110 (6.l). Blood sugar one to two hours after the beginning of a meal should be less than 180 (9.9) and ideally less than 140 (7.8). The hemoglobin A1c ought to be less than 7 percent.

A blood sugar of 70 (3.9) or less should alert your husband that trouble could be brewing, and he ought to retake his blood sugar in 15 minutes. If still low, he needs a snack. An insulin reaction occurs when the blood sugar dips below 50 to 60 (2.8 to 3.3). At that level, people become confused, mumble, sweat, have shaky hands and might lapse into unconsciousness. Immediate treatment with 15 to 20 grams of glucose (tablets obtainable in drugstores) raises blood sugar rapidly. In place of such tablets, hard candy, like 10 Lifesavers, a cup of orange juice, four teaspoons of sugar, or three teaspoons of honey restores blood sugar. An injection of glucagon corrects the situation if the person cannot swallow. Your doctor will give you a prescription if one is necessary.

DEAR DR. DONOHUE: I graduated from college this year. In two weeks, I have a job interview.

My potential employer requires a urine test for drug use. I smoked marijuana a few times, the last time being in May. Will my test show this? — R.D.

ANSWER: No. A casual user of marijuana passes a urine test within a week to 10 days after smoking it. Someone who is a more frequent user might not pass the test for a full month.

Marijuana and the substances into which the body changes it are stored in fat. That’s why it takes so long to clear it.

DEAR DR. DONOHUE: Nine months ago, I was treated for an overactive thyroid gland. The treatment was radioactive iodine. It worked well; my symptoms disappeared.

I think it might have worked too well. Now I am putting on weight even though I have been watching the number of calories I take in. Is the treatment responsible for this? I hate to think I changed one problem for another. — M.M.

ANSWER: People who are treated with radioactive iodine for an overactive thyroid gland usually become hypothyroid — produce too little thyroid hormone. It’s an expected consequence of successful treatment. The radioactivity removes the gland. It’s much like having had surgical removal of the gland without any cutting.

You have to see your doctor. You will probably have to take thyroid hormone in tablet form. This isn’t trading one problem for another. It’s expected. It involves taking only one pill a day.

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.

Copy the Story Link