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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Rizvi for taking part in the program.

December: Diabetes

Question 1
I was diagnosed with Type 2 DM two and a half years ago. I began a weight loss, exercise and healthy eating regimen and got my Glucose readings within normal limits. My Hemoglobin Alc level dropped to 5.1. Unfortunately, I resumed my bad habits and I gained back the weight I lost. My readings skyrocketed. I've gone back on the health regimen and have lost 35 lbs. I am still about 70 lbs overweight but making progress each day. I take 1000 mgs of Glucophage twice a day, in the morning and evening. Also, 5 mgs of Amaryl each morning. Right now, my Glucose readings are usually in the 90 to 100 range. My question is, if I continue to lose weight and get down to my ideal body weight, what is the likelihood of eventually getting off the medication? Also, what residuals and progression of the illness can I expect, assuming I maintain a healthy body weight and exercise regimen?

If you continue to loose weight by modifying diet and doing good aerobic exercise as you have demonstrated before the likelihood of dose reduction is tremendous and may be getting off but when life styles are not maintained sugars would shoot up again requiring medications. Such situations are required to be examined individually and more critically.
According to a recent NIH Study there was a 58% reduction in the incidence of Diabetes with good exercise and dietary modification.

You are on Glucophage which is a great drug that also helps shed some weight in addition to controlling sugars.

I would be happy to discuss things with you in more detail if you choose to see me.

Question 2
About 8 months after I gave birth to my son I visited my pcp. I couldn't understand why I was so tired and couldn't lose the weight. He tested my thyroid and my Tsh came back at about 11. I was put on a synthroid (Levoxyl) right away and we retested after a month. This time only my Tsh. Not my T4 or T3. He said because they were ok before that we didn’t need to worry. His only concern was my Tsh. He told me that it was all due to postpartum. "Thyroiditis"??? I would need to be on pills the rest of my life. Do you find this common in women after birth of a child? I am only 27, and have no family history of thyroid problems. Also shouldn’t all my labs be tested(T4,T3) and not just the Tsh? Shouldn’t my ob-gyn have tested me during my pregnancy? Thank You.

Pregnancy affects thyroid and vice versa. Postpartum or Peripartum thyroiditis,hypothyroidism or hyperthyroidism is not uncommon in Endocrinology practice. You clearly had the hypothyroid state for which you need to be on Levothyroxine and dose need to be regulated every 4-6 weeks until stable and then 3 monthly when stable or even less.

Sometimes it is just transient thyroiditis which clears up soon after delivery and no hormone supplementation is necessary However sometimes Hashimotos thyroiditis or Postpartum thyroiditis ensues which needs definitive treatment as in your case.
TSH, if it is an Ultrasensitive,3rd generation assay by which the lab is testing it would usually be enough but if that’s not the case Free T4 as well as T3 are important gauges specially for fine tuning.

Your tiredness is due to the thyroid condition and once regulated you should start to feel better.

Question 3
My fiancée is a diabetic and is on an insulin pump. He thinks he can eat anything he wants because he can bolus for the foods. I think he should still watch his diet. His sugar count goes up and down constantly, which I also don't think is good for him. If his count is high, he just bolus'. Is this a safe way to control his diabetes or should he still be watching what he eats?

Diet is still important. To be on Insulin pump is great as you have a lot of flexibility and the control buttons are in your hand but at the same time one should not over indulge and eat and drink at will. Dietary discrimination goes a long way in managing diabetes even with Pump.

I had almost a 100 patients on pump and they had to go through extensive training including a session on diet.

Question 4
I would need to know more about you before passing a judgement but there is a recently concluded NIH study showing a 58% reduction in the incidence of Diabetes if Diet and Exercise is combined and 38% reduction in individuals who are on Glucophage. Its a great drug specially if Kidney and liver functions are alright. It is also the ONLY Weight neutral agent in the management of diabetes and does not lead to weight gain and actually weight loss in many.

I would need to know more about you before passing a judgement but there is a recently concluded NIH study showing a 58% reduction in the incidence of Diabetes if Diet and Exercise is combined and 38% reduction in individuals who are on Glucophage. Its a great drug specially if Kidney and liver functions are alright. It is also the ONLY Weight neutral agent in the management of diabetes and does not lead to weight gain and actually weight loss in many.

Dr. Rizv'is answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.