Dr. Keith Roach

Richmond Times-Dispatch - - Comics, Etc. -

Dear Dr. Roach: I am 70 years old and had a kid­ney trans­plant 18 years ago. I de­vel­oped di­a­betes, but it was con­trolled through oral med­i­ca­tion. I re­cently went into the hos­pi­tal for pneu­mo­nia and was given large doses of steroids and in­jec­tions of in­sulin. Now I am un­able to bring my sugar down with the pills I was tak­ing. Could the cause be the in­sulin I was given? Your an­swer would re­ally be ap­pre­ci­ated.  P.I.

Dear P.I.: The ma­jor cause for di­a­betes in older peo­ple is re­sis­tance to in­sulin.

Steroids act against the ac­tion of in­sulin, and tend to make in­sulin re­sis­tance worse. This can precipitat­e or worsen di­a­betes. Any kind of se­ri­ous ill­ness, es­pe­cially in­fec­tion but even some­thing like a heart at­tack, can also worsen di­a­betes. Be­tween the higher dose of steroids and the pneu­mo­nia, it’s not sur­pris­ing your di­a­betes went out of con­trol and you re­quired in­sulin.

The in­sulin you got in the hos­pi­tal was not the cause of the dif­fi­culty con­trol­ling your di­a­betes now. In fact, it may have helped: The pan­creas grad­u­ally loses the abil­ity to re­spond to high blood sugar with pro­longed high blood sugar lev­els, a con­di­tion known as glu­cose tox­i­c­ity. Keep­ing the blood sugar near nor­mal, us­ing in­sulin if nec­es­sary, helps pro­tect the in­sulin-se­cret­ing cells in the pan­creas from dam­age. Cur­rent care is to try to get the blood sugar into a near-nor­mal range as soon as pos­si­ble af­ter di­ag­no­sis while be­ing cau­tious of the risk of dan­ger­ously low blood sug­ars.

Type 2 di­a­betes tends to worsen over time. This is es­pe­cially the case if peo­ple gain weight, another com­mon prob­lem with high-dose steroids. Still, get­ting the blood sug­ars back un­der con­trol now, with weight loss (if ap­pro­pri­ate), care­ful diet and reg­u­lar ex­er­cise, and ad­di­tional oral medication­s or in­sulin if nec­es­sary is still the best way of pro­tect­ing you from wors­en­ing di­a­betes over time.

Dear Dr. Roach: I have COPD and I am on oxy­gen. My cat was chew­ing on my oxy­gen tub­ing, and I thought I would have to give up my pet. A friend sug­gested I get 1/2 inch split con­duit tub­ing at an au­to­mo­tive store. It’s used to wrap wiring in the en­gine to keep squir­rels and other an­i­mals from chew­ing on the wires. You slip the oxy­gen tub­ing into the con­duit tube, and your pet will not chew on it. I hope this helps some­one else to be able to keep their pets. — C.C.S.

Dear C.C.S.: I thank C.C.S. for writ­ing. It’s a so­lu­tion to a prob­lem I didn’t know ex­isted, and I also hope some­body finds it use­ful.

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