DEAR DR. ROACH: Can you tell me why there is so much emphasis on small portions for diabetics or prediabetics? If you are watching carbs and are extremely underweight, is there still a reason to limit portion sizes? — C.

ANSWER: The majority of people in North America with diabetes and prediabetes are overweight or obese, so limiting portion size makes sense for most people. However, for the minority of people with diabetes or prediabetes with normal or below-normal weight, portion size no longer has the importance it does in overweight people.

A careful diet is important for everyone with diabetes. I would be cautious about the term “carbs,” since there are several different types of carbohydrates. Simple sugars and starches are the problem for diabetics, since they are rapidly converted to blood sugar. However, fruits, vegetables and whole grains are much more slowly turned into blood sugar, and along with high-quality protein and healthy fat, form the basis of a healthy diet for everybody — diabetics and non-diabetics alike.

Being underweight with diabetes should raise the possibility of type I diabetes, which is caused by autoimmune destruction of the cells in the pancreas that make insulin. Type I diabetics have no or almost no insulin, and absolutely need insulin by injection. Most people with type I are children or adolescents, but it can happen in adults. Type II diabetes is caused by resistance to insulin. Most type II diabetics have normal or even high levels of insulin. Insulin helps bring sugar from the blood into cells, but it also acts as a growth hormone. That’s one of the reasons type II diabetics have trouble losing weight, since the high insulin levels promote fat deposition. Type II diabetes is more common in adults, but as North Americans continue to have increasing rates of obesity, type II diabetes is showing up at younger and younger ages.

The situation is even more complex than I have made it here. There are people with elements of both type I and II diabetes, and even rarer types. I believe type I diabetics should be managed by an endocrinologist. Sophisticated blood tests, including insulin, C-peptide and insulin antibodies, occasionally are necessary to sort out what kind of diabetes is present.

DEAR DR. ROACH: My husband has numerous skin tags under both arms. Now he’s starting to get them around his neck and on his eyelids. We’ve been told to tie a string around them, or a dermatologist he saw told him to get a good pair of cuticle scissors and cut them off, but there’s way too many to do that. Is there anything else we might try? — R.L.

ANSWER: Skin tags are benign growths that are very common on the neck, armpits, groin or other places where skin rubs. They are harmless, and nothing needs to be done about them unless they are cosmetically important. The best way to remove them is to have a dermatologist or other expert remove them directly. I don’t recommend trying to remove them yourself with scissors, since I have occasionally seen them bleed enough after removal to require a stitch.

The last time I wrote about skin tags, several readers wrote to recommend Tag Away, an over-the counter product. It may be worth a try, although the reviews about this product are rather mixed.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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