DEAR DR. DONOHUE: What advice can you give to senior citizens with type 2 diabetes? — W.S.

ANSWER: People with either type 1 or type 2 diabetes have similar goals and are given fairly similar advice. Type 2 diabetes used to be called adult onset diabetes and often can be controlled with oral medicines and diet. Type 1 diabetes used to be called juvenile diabetes, and it requires insulin treatment. Those older designations are misleading. Many type 2 diabetics have to take insulin.

People with diabetes ought to have a meter that provides the blood sugar (plasma glucose) reading. It’s impossible to adjust medicine or diet without such information. The first reading in the morning, before taking food, ought to be in the range of 70 to 130 mg/dL (3.9 to 7.2 mmol/L). The blood sugar meter is not expensive, and is easy to use. In addition, hemoglobin A1C, another measure of sugar control, should be less than 7 percent. This value is obtained only a couple of times a year.

Since diabetes is a risk for developing heart attacks and strokes, diabetics are obliged to control the other risks for those two common conditions. Those are blood pressure, which should be less than 140/90 and preferably under 130/80. Cholesterol ought to be lower than 200 mg/dl (5.2 mmol/L). LDL cholesterol (bad cholesterol) is best kept under 100 (2.6) and the optimum reading for triglycerides (blood fats) is now set at 100 mg/dL (1.13 mmol/L). Diabetics ought to have yearly eye exams.

Since obesity is common in type 2 diabetes and since modest weight loss (a 5 percent to 7 percent reduction in body weight) can help, calorie reduction is important.

Increased activity controls blood sugar and body weight. The goal is 30 minutes of moderate exercise on most days of the week.

Diabetics should get instructions in diet control from a dietitian. In general, 50 percent to 55 percent of calories come from carbohydrates, 15 percent to 20 percent from protein and 30 percent from fats.

The booklet on diabetes presents this illness and its treatments in detail. Readers can obtain 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My husband was discovered to have sleep apnea. He is now on CPAP (continuous positive airway pressure) at night. The problem is that he sometimes gets up as many as 14 times a night to void. I have him on a nonprescription sleep preparation, but he still gets up. Lack of sleep makes him angry. — L.C.

ANSWER: You’re directing your efforts in the wrong direction. His prostate gland is making him get up during the night. His gland doesn’t allow his urinary bladder to completely empty. He urinates only in dribs and drabs.

Medicines can enhance bladder emptying. And there are many office procedures that don’t entail long surgery or long recovery that can open up his drainage system.

Take your husband to a urologist.

DEAR DR. DONOHUE: Since 1996, I have passed a uric acid kidney stone about every eight months. Allopurinol was prescribed. Since then, I continue to pass stones, but I have no pain. In March of this year, I had the first painful stone. An MRI showed it lodged in my ureter. I took potassium citrate pills, but it’s still there. The doctor wants to do a laser lithotripsy. Since there is no discomfort, is this necessary? — L.F.

ANSWER: Your urologist knows the state of your ureter (the tube that drains urine from the kidney into the bladder) better than you or I. If the ureter is obstructed by the stone, urine might be backing up into your bladder. That can be deleterious if left untreated.

I’d go along with your urologist if I were you. The procedure isn’t painful, and recovery is rapid.

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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