Are diabetes meds working?

My husband is an over-the-road truck driver, and he is 68.

He has been on metformin for a long time, and I have been reading that this medicine does not help bring down blood sugar. He is also using human insulin two times a day.

What I want to know is if there's a better medication for him to take? I think he is gaining weight from insulin resistance, since he is getting a bigger belly, and his primary care physician doesn't seem to care about the issue, even though I have brought it to his attention.

DEAR ANON. ❯❯ Metformin is considered the best initial treatment for most people with Type 2 diabetes, due to its long history and excellent safety profile. There are also a large number of studies that found that the long-term outcomes are better for people taking metformin than they were with the other drugs that were available at the time the studies were done. It is true that metformin by itself is unlikely to cause the blood sugar to get too low, but it certainly reduces high blood sugar very well. Unfortunately, by itself, it is often not enough to control blood sugar.

Medication alone is not the best treatment for Type 2 diabetes. Regular exercise and a healthy diet are critical parts of a diabetes treatment plan. When these aren't enough (and regular exercise is very difficult for professional drivers), many diabetes experts will choose a different type of medication now — when before insulin was the best option.

I worry about insulin in a truck driver because it may cause the blood sugar to get too low. Another problem with insulin (and medications that cause the body to release more insulin, such as glyburide) is that these tend to worsen insulin resistance and promote weight gain (especially around the belly, where it is most associated with heart disease).

Although we do have drugs that work directly for insulin resistance, drugs in the GLP-1 agonist class (such as liraglutide and semaglutide) have been shown to reduce the risk of heart disease in those who are at high risk. These also promote weight loss, but the main point is that they protect against serious complications.

I certainly don't have enough information to recommend a particular medicine for him, but getting a second opinion from an expert in diabetes is a prudent step at this point, in my opinion.

I am a 76-year-old female and have had alopecia since I was 5. I also take Synthroid. When I was receiving one of my COVID shots, I was asked if I had an autoimmune disease. I said I didn't have the faintest idea. Later, I heard that alopecia was an autoimmune disease, instead of the usual saying, “No hair, no reason, no cure.” My questions are: How do I know if it is? And why was it important to know for the shot?

Alopecia is a general term for hair loss, and several kinds of alopecia are thought to be autoimmune in nature, with the body's immune system attacking the cells that grow hair. Most cases of thyroid disease are autoimmune as well. People with one autoimmune disease are at a higher risk for others.

The COVID vaccine may be less effective in some people with autoimmune diseases when they are taking medicines to suppress the immune system. Further, when vaccines were in short supply, those with immune system diseases were at a higher priority to get the vaccine. Now, however, there is no reason for you to take the COVID vaccine differently from anyone else.

ACROSS 1

5

10 14

15

16 17

20 21

22

23 25

26

32 34

35 36 37 38 39

40 42

44

47 48 49

52

U.S. territory in Micronesia Mushroom’s reproductive cell Situated on “Round on the ends and high in the middle” state Tanker filled with tankfilling fluid Make a donation Promising young horticulturist? Luster Golf course standard Chemically nonreactive Entice Use a plus sign Promising young pilot? Made up (for) Foreboding forewarning Kanga’s kid Drink a lot Drink a little Baby wolves Crossed paths Related Religious dissent Promising young scuba instructor? Granola morsel GPS guesses City known for its Heat Hit the moguls 54

58 61 62

63 64

65 66

2 3

4

5 6

7

8 9

10

11 12 13 18

19

Religious rationalist Promising young banker? Low-level worker Large concert venue Dove’s home Tools with teeth

Full of the latest

“Fill in this answer or ___!”

DOWN 1

Oodles and oodles “Nope” Senator’s assistant Posing for a fashion magazine, say

Jr., to Sr. Perpetually filthy “Peanuts” character Actress Kurylenko or gymnast Korbut Backside Spell “maybe” “mabey,” maybe Business plan? Fork prong Done with Sassy Currently occupied Brought about the destruction of 24 25

26 27 28

29 30

31

32 33

37 38 40 41

42 43

45

Purge (of) Wide st. like a blvd. Way to get there

On the way out Ax-wielder’s accessory? More loyal “I’m such a butterfingers!” Like a promising future Highest point Those people Wrath or envy Felt-but-notseen spirit “Until we meet ___” DIY purchase Chart-topper Give the runaround Hadrian’s subjects 46

49

50

51 52

53 55 56 57 59

60

Does something beneath one’s dignity Illustrations at the front of many fantasy novels What a concept! Admit openly “Your majesty” Didn’t just suppose Object of worship Matching groups Sequoia or sycamore Coconut milk container ___ it on thick