I have had physical therapy, an epidural steroid injection, numerous prescriptions for pain, muscle relaxers and have done home exercises recommended by my physical therapist. All provided only temporary relief, and my doctor has said I’ve reached my maximum medical improvement. Actually, there has been no improvement.

Despite my best efforts, I have had absences from work in excess of my former employer’s guidelines and, after six years, was terminated. This, of course, has resulted in financial problems.

After five to six weeks of feeling lethargic, experiencing extreme thirst, blurred vision and weight loss, I visited my doctor on Aug. 27, 2010, and was diagnosed with type 2 diabetes. No one in my family has ever had diabetes.

Could the physical distress and mental anguish from my accident have contributed to this condition?

DEAR READER: If I understand you correctly, you were diagnosed with diabetes 466 days after your accident. In the interim, you obviously saw a number of healthcare providers who failed to either order lab work or zero in on the diagnosis.

Glucose is the primary source of energy in our cells that make up muscles and other tissues. As food is digested, sugar is absorbed into the bloodstream. With the aid of insulin, cells are able to absorb the sugar and convert it to energy. When type 2 diabetes occurs, cells become resistant to the insulin and/or the pancreas is unable to produce adequate amounts of insulin. As a result, sugar builds up in the bloodstream.

Long-term complications can include nerve damage, pain, and tingling and numbness that commonly begin in the toes and fingers and gradually spread upward through the body over a period of months or years. The kidneys, bones, joints and other areas of the body can be damaged, as well.

My guess is that your neck pain and headaches were and are the result of the accident. You had major trauma to your head and may have even suffered a concussion. There is evidence that stress can cause sugar levels to elevate in known diabetics. This still leaves a big question unanswered as to whether stress is a trigger in a person with no prior history. Perhaps some light can be shed on the matter if your physician has lab results in your file done prior to and following the accident. Request a review of the results to determine whether there was a gradual increase in readings that might not have been identified prior.

From the copies of the MRI results you sent, I can see that you are 67 years old. Is there a possibility that because of your pain, headaches and lack of employment that you have gained a little weight and become sedentary? Are you exercising as much as possible under the circumstances and eating well-balanced meals? Everything we do affects our bodies in positive or negative ways. Sometimes simple lifestyle changes can make an enormous difference and even allow for previously prescribed diabetic medications to be reduced or eliminated.

Take a positive view. Work daily on a healthier lifestyle, and try to prove your doctor wrong. Perhaps you haven’t reached your maximum medical improvement. I would like to hope you are 67 years young and can overcome your devastating accident.

To provide related information, I am sending you a copy of my Health Report “Diabetes Mellitus.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com. Good luck.

Although they are not overweight, they have terrible eating habits. I went to the supermarket with one of them and watched as she loaded her cart with pancake mix, syrup, diet soda and several boxes of processed frozen dinners that were advertised as healthy but contained huge amounts of sodium.

Her concession to the fact that she has diabetes was buying light syrup and some bananas. She did not have a single vegetable other than what was included in her frozen meals. She also leads a sedentary life.

She is constantly complaining about her “bad genes.” When I suggested that her diabetes might be due to her eating and exercise habits, she explained that she is not obese and therefore did not cause herself to become diabetic.

I don’t know what her doctor has told her regarding lifestyle, but in general it does seem to me that type 2 diabetes is looked upon as your fault if you are heavy but beyond your control and the result of “bad genes” if you are thin. I think this is a dangerous mentality and also quite untrue.

DEAR READER: Absolutely. Type 2 is the most common form of diabetes. It is commonly associated with being overweight, but this does not mean that simply being overweight will cause you to develop diabetes. Rather, excess weight is simply a risk factor. Other risk factors include a family history, leading a sedentary life, age, ethnicity and more. Diabetes may be associated with other health conditions, such as high blood pressure and abnormal cholesterol levels.

Type 2 diabetes is caused when cells become resistant to insulin and the pancreas is unable to make enough insulin to overcome the resistance. When this occurs, the cells no longer take in sugar, causing it to build up in the bloodstream. The exact reason why this happens is unknown.

Symptoms can include increased thirst, extreme hunger, slow-healing sores, frequent urination, unexplained weight loss, fatigue, frequent infections and blurred vision.

Complications can arise from untreated or poorly managed diabetes. Short-term complications need to be addressed immediately because, if left untreated, they can lead to seizures and/or coma. Short-term issues include hyperglycemia (high blood sugar), hypoglycemia (low blood sugar) and increased ketones (potentially toxic acids) in the urine.

Long-term complications develop gradually. If the diabetes is left untreated or poorly treated, these can become permanent or life-threatening. Long-term issues include cardiovascular disease, bone and joint problems, skin and mouth conditions, and nerve, eye or kidney damage.

Type 2 diabetes is often preventable if proper steps are taken to manage risk factors. It is important to maintain a healthful diet and exercise routine. Remember to include plenty of fruits, vegetables and whole grains while reducing your intake of animal products and sweets. Simply substituting sugar-free products for normally sugar-laden treats is not helpful. Any excessive intake of simple or complex sugars (carbohydrates) can result in high blood-sugar levels. A registered dietician is an excellent resource in developing a meal plan.

Exercise can lower blood sugar and decrease insulin resistance. For those with diabetes, aerobic exercise is the most beneficial and should be included most days of the week for at least 30 minutes per day.

In those who develop the condition regardless of lifestyle changes, treatment is available. These include medication to stimulate the pancreas to produce more insulin, inhibit the production and release of glucose causing cells to need less insulin to transport sugar, block the action of enzymes that break down carbohydrates, or make tissues more sensitive to insulin and insulin injections.

As you can see, simply being overweight isn’t enough to cause diabetes. While your friends may be thin, they likely have risk factors for developing diabetes and have, thus far, failed to make the necessary changes. They are accountable for their health, and blaming “bad genes” is just an excuse. They must change their lifestyles and not rely only on medication to solve this problem.

People who are overweight can benefit greatly from losing weight, and in some cases, that may be all that is necessary to improve or even reverse type 2 diabetes (or high cholesterol or high blood pressure). Those with normal weights still need to be accountable and make changes.

To provide related information, I am sending you a copy of my Health Report “Living with Diabetes.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: There are a number of reasons why you might have a few random high readings. Perhaps you ate out and consumed something the evening before your testing that had a higher-than-normal amount of sugar included. Or you’ve experienced trauma, had a minor illness, consumed alcohol, or have been placed on a medication that affects your readings.

I would certainly keep a close eye on it but would not jump the gun to consider medication at this stage. Watch your sugar intake. Eat healthful meals, avoid sugar, reduce your carbohydrate intake, and exercise appropriately.

To provide related information, I am sending you a copy of my Health Report “Diabetes Mellitus.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Diabetes is a disorder in which blood-glucose levels are above normal. People develop diabetes either because the pancreas doesn’t produce adequate insulin or because the cells in the muscles, liver and fat don’t use insulin properly. This results is glucose remaining in the blood and elevating levels at the same time cells crave the energy necessary to function properly.

There are two types of diabetes, type 1 and type 2, with the latter being most common. Type 1 indicates a person is dependent on insulin and requires regular injections that are self-administered because the body fails to produce enough, if any, insulin. This form generally develops before the age of 30 and affects about 10 percent of all diabetics. Type 2, on the other hand, signifies insulin resistance. These people produce adequate insulin levels, but the body is unable to use it properly. Some may even need insulin injections in order to stimulate the pancreas. This form can occur in people of all ages and is more prevalent in obese people, Hispanics and Native Americans. Some cases of type 2 diabetes have a strong genetic basis while others do not. There does appear to be hereditary susceptibility, but this is not always the case in those who develop diabetes.

Symptoms include fatigue, an increase in hunger and thirst, blurred vision and skin ulcers that don’t heal well. Complications can be serious and can include heart disease, stroke, poor vision, kidney failure, nerve damage, poor circulation and a host of other conditions.

Prevention is key with the disorder to prevent your diabetes from progressing to type 1. If appropriate, try to lose weight, since excess weight can keep your body from making and using insulin properly. Reduce your salt and alcohol intake. Make better choices when grocery shopping. Keep fresh vegetables such as carrot and celery sticks readily available to snack on while watching television. Eat properly and coordinate a program of regular exercise, such as riding a bicycle or golfing. A simple walk around the block daily is good. Ask your physician or endocrinologist if referral to a dietician would help. If you have a community center nearby, sign up for swimming or aerobics classes. Get a friend to join you. There’s more incentive if you have company.

If medication is appropriate, take it according to your physician’s directions. Follow my No Flour, No Sugar diet. I have received countless communications from readers stating they have brought their diabetes, cholesterol levels and hypertension under control and have been able to discontinue their medication while on my diet. Stay active and in control. With a little motivation, help and direction, you should see amazing results.

To provide related information, I am sending you a copy of my Health Report “Living with Diabetes Mellitus.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I will see my doctor in August. She will not be happy, but I really do not care.

DEAR READER: The medication you have been prescribed (Fosamax) and the calcium with D supplement are both in the proper dosage to combat osteoporosis. I am sure your prescribing physician indicated that you should take the alendronate with a full glass of water a half-hour prior to your first food of the day. It should not be taken at bedtime with food, mineral water, coffee, tea or juice, as these beverages will reduce the absorption of the medication.

One inactive ingredient in the product is lactose, a sugar commonly found in milk that is used as a diuretic in some medications. I am uncertain exactly how much lactose is in alendronate but herein could be your problem. I read about one individual who was part of a 2009 study involving almost 50,000 men and women who indicated his or her sugar level rose 10 points and continued to rise while on alendronate. There was no further documentation or comment so I can only pass the information on to you. Beyond that observation, I have been unable to find any documented test studies that confirm elevated sugar levels in people who have been prescribed the medication.

I assume you have bone-density testing (DEXAs) on a timely basis and suggest you have another at the appropriate time. Determine any progress since being on the medication and then have a frank discussion with your primary-care physician about your concerns. If there is no improvement in your osteoporosis, perhaps she will be responsive to your discontinuance of the medication, even if it is only for a short trial period. In the interim, I cannot see that the calcium with vitamin D will do any harm and in fact, it might be just what the doctor ordered, if you will excuse the pun.

You have a right to make decisions regarding your health. Your doctor should either present an opposing view as to why the alendronate sodium should be continued, make a substitute to something you both agree upon, or she should go along with your decision. Perhaps an appointment with a nutritionist might even be appropriate.

If there is no other basis for your elevated sugar counts, express your concerns. I can understand and support a physician taking aggressive steps to prevent fractures in a woman your age. Yet, if there is a direct connection to it causing the elevation, the last thing you need is to replace one medical problem with another. In the interim, exercise as much as possible and eat a healthful diet rich in fruits and vegetables. If questions still remain in your mind, request a referral for a second opinion.

To provide related information, I am sending you copies of my Health Reports “Osteoporosis” and “Diabetes Mellitus.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

DEAR READER:
It is not the fault of food and drink manufacturers that Americans are obese and in poor health. Each teenager and adult is responsible for the types of foods and drinks consumed. No one is forced is eat high fat, high sugar foods. The only exception to this is babies, toddlers and young children who do not know any better (unless taught by their parents).

So, before blaming food manufacturers, look around. Healthful alternatives are available. If we as a whole started purchasing and consuming more fruits, vegetables and low-fat, low-sugar foods, we would all become healthier. “Bad” foods would become more expensive, “good” foods would become cheaper and our nation would more readily accept apples and carrots rather than chocolate and potato chips as a snack .

The rest of the world seems to know this. Americans who travel abroad often complain about it, but perhaps we need to take a page from that book. This would make the choice easier; however, it is still individuals’ rights to eat what they please, even if it carries very real and potentially serious consequences.

I’m an 83-year-old man with type 2 diabetes and am medicated pretty well. I walk sometimes but usually get little exercise. I am starting to have bad cramps at night and my legs are getting very weak. I fear losing my feet and lower legs.

Frankly, I love having a 3 oz. glass of red wine before lunch and twice that before dinner. I also love my 4 oz. dish of iced cream at about 9 PM. Are these habits which give me pleasure doing me in? Please advise me.

DEAR READER:
As you are aware, type 2 diabetes is non-insulin dependent and is the more common form. The pancreas continues to produce insulin but the body develops resistance to its effects, resulting in a deficiency. While the condition can affect people of every age, it most commonly occurs after the age of 30. Age, weight and heredity are major risk factors for type 2 diabetes.

Long-term complications can result in poor circulation that might lead to heart disease, stroke, infection, poor vision, kidney failure and nerve damage. An individual might experience gradual weakness of the arms or legs, tingling and accompanying pain of the hands and feet, difficult healing of the skin, infection, and more.

It appears that the leg weakness and cramps are among your list of unpleasant side effects. You admittedly do not exercise on a regular basis and this activity is extremely important for all diabetics. Make a plan that works for your lifestyle. Perhaps that translates simply to walking around the block every day. If you have access to a swimming pool at a community center, take advantage of the resource. Perhaps a stationery bicycle indoors will work. Your circulation is likely impaired. While you may not be able to reverse the situation completely, you can definitely take steps to improve it. Start now.

There are several remedies for the leg cramps. The first is simply to remove the wrapper from a bar of soap. Place the soap under your bed sheet at night, where your legs ordinarily rest. This should eliminate the cramps. Some people have even had success with rubbing a bar of soap on the calves of their legs. Do what works best for you.

Pickle juice or a dill pickle incorporated into your diet may help prevent muscle cramping. Both products are available in grocery stores. Numerous drinks (to include pickle juice) contain electrolytes. Read labels at your local market before making a selection.

If your medication keeps your sugar levels under good control, I urge you to continue with the medications prescribed. If you are dissatisfied with the physician you are seeing, request a referral to another primary care physician or to an endocrinologist, a specialist in the field.

To give you related information, I am sending you a copy of my Health Report “Living with Diabetes”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

About 30 years ago I became hyperthyroid and lost a tremendous amount of weight. I then became hypothyroid and my menses stopped abruptly, never to reappear. I was told my thyroid condition was responsible for both.

I’ve developed a very large stomach, although my arms and legs are thinner. I’ve been tested several times for uterine cancer with consistent negative results. My face is also puffy and more rounded.

I’ve had periodic back aches that are so severe I can hardly walk. I’ve become diabetic and two years ago was put on insulin. This year my high blood pressure became permanent, even though my stress and anxiety levels are low, and lately I am always tired. It seems some of my symptoms are escalating while others — the backaches, depression and anxiety — have disappeared. I would think the insulin is responsible for my sleepiness and exhaustion after slight exertion, but I’ve had most of these symptoms for 10 to 30 years.

Until I read about Cushing’s, I felt hopeless, alone, and resigned to the fact that these were side effects of my medical conditions. Can the tests be wrong and if not, do you have any idea what could be occurring? I’d like to have some energy so I can at least function the way I did two years ago.

DEAR READER:
The common signs and symptoms of Cushing’s include abdominal weight gain, fatigue, a rounded face, depression, anxiety, and high blood pressure. The most common cause is the use of oral corticosteroid medication. The main issue here is that Cushing’s is difficult to diagnose since it shares many symptoms with other conditions.

Symptoms of hypothyroidism include weakness, a cessation of menstruation, fatigue, an extended abdomen, facial puffiness, and more. Symptoms of diabetes include fatigue, weight loss, blurred vision, poorly healing wounds, and more. Sound familiar?

I feel I am removing any hope you might have of putting a diagnosis to your symptoms, but I do not feel you have Cushing’s. Rather, the laboratory work you included with your letter indicates you do have diabetes and hypothyroidism, exactly as you pointed out. The problem is that neither condition is under complete control, despite the insulin and Glucophage for your diabetes and the Levothyroxin for your hypothyroidism.

Return to your primary care physician for referral to an endocrinologist, if you aren’t already seeing one. Sit down with your list of questions to determine together what can be done to bring both conditions under control. Once that happens, your blood pressure should drop, your fatigue should disappear, your energy should return, and life should be back to a more normal state. It’s often difficult to hit upon the right dose for a particular condition, but through the process of trial and error, it can be done.

To give you related information, I am sending you a copy of my Health Report: Living with Diabetes Mellitus”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My feet are now showing some nerve damage. Any help would be appreciated.

DEAR READER:
Metformin is an oral medication prescribed for people with type II (non-insulin dependent) diabetes. The normal dosing for oral medication is 500 mg taken twice daily, while the extended release form is taken once daily in a 500 mg tablet. Therefore, I am rather surprised you are on 2000 mg daily. This appears to be a hefty dose with less than perfect results. Normal blood sugars run in the 70-150 range, with lower readings in the morning and higher readings in the evening and after meals. To have a morning reading of 160 on this elevated dose is somewhat disturbing.

The nerve damage in your feet sounds like peripheral neuropathy to me, a condition that causes pain and numbness of the extremities. It can result from infection, traumatic injuries and is seen commonly in poorly controlled diabetics. Symptoms often improve over time once the underlying condition is treated.

Lactic acidosis has been reported in some people on metformin. The condition presents as muscle or abdominal pain, lightheadedness, shortness of breath, weakness, sleepiness and a slowed heart rate. Individuals should avoid alcohol while taking this drug, as it lowers blood sugar readings and can increase the risk of lactic acidosis. As with so many other drugs, several medications can interact with metformin, so advise your physician of anything else you might be taking, including herbal supplements and over-the-counter medications. He or she will then be able to determine if the drug is right for you.

In response to your cinnamon regimen, this product has been used for many conditions, including stomach disorders, nausea, vomiting, diarrhea, gas, and bloating. Most recently, scientists have discovered as little as ½ teaspoon daily added to the diet may reduce blood glucose levels. Cinnamon can be added to your toast, sprinkled over cereal, or a stick can be swirled into coffee or tea. Having reported this, I should add that this therapy does not work for everyone. In fact, I often feel that if an individual concentrates on adding a supplement for a specific purpose, he or she rapidly becomes aware of everything consumed. This is likely to lead to better dietary choices that result in better readings.

Review your concerns with your primary care physician. He or she might choose to switch you to another drug in the same class, but in a lower dosage that will provide better results. You might also consider asking for a referral to an endocrinologist who specializes in diabetes. Such a physician will be armed with the newest drugs and research results available. Perhaps one such drug will be right for you.

To give you related information, I am sending you a copy of my Health Report “Diabetes Mellitus”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I see a primary care physician at a VA clinic, a local internist, urologist, cardiologist, and a neurologist. I have type 2 diabetes and have had episodes of atrial fibrillation in the past. My medications include Metformin, simvastatin, warfarin, flecainide, a daily multi-vitamin, and monthly B12 injections. Further, I had partially successful atrial ablation in 2006 and cryotherapy for prostate cancer in 2007. My blood pressure readings and lab testing for diabetes are always great.

After an MRI I was told I do not have Parkinson’s disease, but Parkinsonism symptoms. Two trials of carbidopa/levodopa gave initial improvement that faded after several days — even with dose increases.

Do you have any thoughts on why my legs have become progressively weak? Any ideas would be appreciated.

DEAR READER:
You appear to be plugged in to the appropriate specialists to handle the plethora of medical issues with which you have had to deal. In spite of this, I will attempt to cover one issue at a time, so bear with me.

Your type 2 diabetes is stable on the Metformin dosage prescribed. The atrial fibrillation is held in check with the Warfarin and Flecainide. You don’t indicate you have high cholesterol readings. I must interpret, therefore, that the Simvastatin was prescribed for both your cardiac condition and diabetes. The B12 injections and multi-vitamins are for fatigue and as a boost for what might be lacking in your diet.

Now on to the biggest issue. Symptoms of Parkinson’s include tremor, rigidity, stooped posture, shuffling gait, fatigue, lack of facial expression, and more. General weakness is relatively common with this neurodegenerative disorder.

You appear to have several symptoms associated with Parkinson’s disease but were not given a diagnosis as such. This leads me to believe that you may have some other condition causing them.

Parkinsonism’s symptoms can be caused by many conditions other than Parkinson’s disease including, drug-induced Parkinson’s, normal pressure hydrocephalus, vitamin deficiency, arteriosclerosis, and more.

You need to have a full neurological work-up including blood testing and a review of your current medications. To the best of my knowledge, there is no test to diagnose Parkinson’s disease but there are tests for other disorders which can be performed to rule out other causes.

Given the fact that you have symptoms of Parkinson’s disease and responded to dopamine therapy (even if for a brief time), I believe you may truly have the disorder despite the fact that your MRI said otherwise. (Again, I don’t believe that an MRI can confirm or rule out Parkinson’s, rather it is based on symptoms, etc.)

I recommend you get a second opinion from another neurologist who may be able to help you more than your current specialist. Let me know what happens.

To give you related information, I am sending you a copy of my Health Report “Parkinson’s Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.