r To Your Good Health

By KEITH ROACH, M.D.

Dear Dr. Roach: I am a 67-year-old man, in excellent health, who takes no medications and is very proactive about maintaining good health: I do fitness three days a week, yoga three days a week and I fast on Saturdays. On Sundays, I take weight, blood pressure and blood sugar readings. I am writing to you about my blood sugar readings. My fasting blood sugar readings are uniformly in the 90s, probably averaging 93. A friend suggested that I also should check my blood sugar reading one hour after eating. I did that, and it was a shocking 173. I have no symptoms or complaints concerning anything that might be related to blood sugar. Is this normal? Should I be checking into something, like diet, as a result of this? — L.A.

Answer: This is not normal. If confirmed by a second test, you meet the diagnosis of diabetes, almost certainly Type 2. In early diabetes, the only defect is the inability to respond to a sugar load. That’s the reason a glucose tolerance test remains the best test to make the diagnosis of diabetes, even though it can be diagnosed by high fasting blood sugars (eventually), or by the A1c level (a measurement of overall blood glucose level in the past several weeks). You need to see your regular doctor or a diabetes specialist.

I am not yet a proponent of intermittent fasting (I am conservative, and won’t recommend a drastic change in lifestyle without good evidence). In people with diabetes, I think this idea is particularly bad. Regular meals are important, and their composition is critical. In early diabetes, it’s the sugar load that the body has a hard time with. Since processed carbohydrates (such as white bread) are rapidly converted to sugar, the key is to have meals with protein and healthy fat, and to make the carbohydrates you eat come more from vegetables. I recommend you also see a registered dietitian nutritionist, who can help you with personalized information.

While you may need medication, at this point a very careful diet may be all that is needed to lower your blood sugars after eating and to prevent progression. In most people, weight loss also can reverse the resistance to insulin that is the hallmark of Type 2 diabetes.

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Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803.

Health newsletters may be ordered from www.rbmamall.com.

r To Your Good Health

By KEITH?ROACH, M.D.

Dear Dr. Roach: I regularly see information and research for men with hormone issues (testosterone) and resulting problems with impotence, etc. I have not seen any interest in clinical testing for women who are refused hormone replacement therapy due to past breast cancer (and, in my case, also a complete hysterectomy several years ago). Not only has my desire for physical intimacy completely disappeared, but the hot flashes and sweating are out of control — that is to say, 24/7. I experience depression and lack of energy, as well as lack of interest in traveling or things that usually attract me.

My situation is not unique, as numerous women with whom I’ve spoken are suffering the same issues. Can you help with some solution? — Anon.

Answer: Women with a personal history of breast cancer almost always are advised against taking hormone replacement therapy. Despite some trials that did not show clear harm, I cannot recommend estrogen via pill or patch.

You are describing some common symptoms of postmenopausal women, including low libido and hot flashes. Depressive symptoms, including feeling down, a lack of energy and loss of interest, also are more common in women around menopause.

I hope I can help with another solution, and I would start with a doctor you trust. Since you can’t safely get estrogen, you need to consider alternative treatments. There are nonpharmacologic options for libido, hot flashes and depressive symptoms. However, there are also pharmacologic treatments. For low libido, testosterone therapy sometimes is used.

A new drug, flibanserin, is very modestly successful. It is indicated only in premenopausal women, but one well-done study showed that post-menopausal women had similar results and side effects.

For hot flashes, nonhormonal treatment, such as venlafaxine or paroxetine, is effective. As these are antidepressants, they may be effective against your symptoms of depression, lack of energy and lack of interest in things you used to enjoy.

I don’t have all the answers, but I think a careful provider, listening to all of your symptoms, will try to find a course of action. There may not be a perfect solution, but I am sure there is help.

Dear Dr. Roach: I have been fighting dry mouth for six years now. I have seen two dentists and five doctors, and they all seem to shy away from my problem. Only one doctor has actually looked in my mouth. The dentist only wants to pull teeth and build a bridge.

I have taken all the over-the-counter medications, and nothing helps. My mouth is dry all over, and on the left side, my mouth gets raw. What is the problem? — M.M.

Answer: Severe dry mouth is not a common problem, but it is important — unless it is treated promptly, it is associated with rapid tooth decay and loss. I see severe dry mouth most commonly with Sjogren’s syndrome — an inflammatory disorder where salivary glands are damaged by the inflammatory response — and in people with head and neck cancer who have undergone surgery and radiation. However, dry mouth also can be related to medications or other diseases.

Treatment for dry mouth has to be individualized. Some people do well using sugar-free hard candies or dried fruit to stimulate saliva production. Other people may need saliva substitutes (there are several), or medications that increase saliva production (such as pilocarpine). All people with this problem need a dentist with experience treating people with dry mouth. I am disappointed by the care you report receiving, and I think you can find better.

Readers: The booklet on macular degeneration explains this common eye ailment. Readers can order a copy by writing:

Dr. Roach

Book No. 701

628 Virginia Dr.

Orlando, FL 32803.

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.

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 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

r To Your Good Health

BY KEITH ROACH, M.D.

Dear Dr. Roach: I regularly see information and research for men with hormone issues (testosterone) and resulting problems with impotence, etc. I have not seen any interest in clinical testing for women who are refused hormone replacement therapy due to past breast cancer (and, in my case, also a complete hysterectomy several years ago). Not only has my desire for physical intimacy completely disappeared, but the hot flashes and sweating are out of control – that is to say, 24/7. I experience depression and lack of energy, as well as lack of interest in traveling or things that usually attract me.

My situation is not unique, as numerous women with whom I’ve spoken are suffering the same issues. Can you help with some solution? – Anon.

Answer: Women with a personal history of breast cancer almost always are advised against taking hormone replacement therapy. Despite some trials that did not show clear harm, I cannot recommend estrogen via pill or patch.

You are describing some common symptoms of postmenopausal women, including low libido and hot flashes. Depressive symptoms, including feeling down, a lack of energy and loss of interest, also are more common in women around menopause.

I hope I can help with another solution, and I would start with a doctor you trust. Since you can’t safely get estrogen, you need to consider alternative treatments. There are nonpharmacologic options for libido, hot flashes and depressive symptoms. However, there are also pharmacologic treatments. For low libido, testosterone therapy sometimes is used.

A new drug, flibanserin, is very modestly successful. It is indicated only in premenopausal women, but one well-done study showed that post-menopausal women had similar results and side effects.

For hot flashes, nonhormonal treatment, such as venlafaxine or paroxetine, is effective. As these are antidepressants, they may be effective against your symptoms of depression, lack of energy and lack of interest in things you used to enjoy.

I don’t have all the answers, but I think a careful provider, listening to all of your symptoms, will try to find a course of action. There may not be a perfect solution, but I am sure there is help.

– – –

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 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.