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Dr. Bill's Commentaries

Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

More Diabetes Questions   (April 12, 2012))

Several miscellaneous diabetes-related questions have accumulated, and I thought I'd tackle some of them here.

  • What is the normal blood sugar level for someone over 300 pounds?

The values that are considered to be normal for blood sugar are not dependent upon weight. (The only situations that have different ranges are pregnancy and infancy).

Fasting glucose values are usually considered normal if below 100 mg/dl (5.6 mmol/L); diabetes levels are 126 mg/dl (7 mmol/L) or above; in-between are considered "prediabetes." (See How to Tell if You Have Diabetes or Prediabetes).

  • I  was told I have chronic kidney disease stage 4 How serious is this?

It's very serious.  The National Kidney Foundation (NKF) has divided chronic kidney disease (CKD) into five stages, and created guidelines to help doctors identify each level of kidney disease. Stage 4 is also called "Severe CKD," and people with Stage 4 CKD will probably need dialysis or a kidney transplant in the near future. If you haven't yet been referred to a kidney specialist (nephrologist), demand a referral.

See Stage 4 of Chronic Kidney Disease for additional information.

  • Could my memory loss be related to diabetes? I'm only 48. I saw a diabetes specialist and she forwarded something to my PCP. When I asked him about it he just smirked and shook his head.

Memory loss may be due to a zillion different reasons, including diabetes. (1) Poorly controlled diabetes can cause memory loss. For example, during hypoglycemia, the brain just doesn't function well, and memory can be affected. (2) There have been studies showing that elderly PWD have a greater than expected risk of Alzheimer's dementia. (3) And recently, statin medications (which are frequently prescribed for PWD who have high cholesterol levels) have been identified by the FDA as having the "potential for generally non-serious and reversible cognitive side effects (memory loss, confusion, etc.)."

None-the-less, I'm surprised at the reaction that your PCP had after reviewing the specialist's report. I'd think it would be very appropriate for you to ask for the details of the report, and get advice on what to do next. If your memory is worsening at your young age, I'd think that referral to a neurologist, or a similar specialist, would appropriate for further evaluation.

  • Can you suggest any home remedies for sleepiness due to diabetes?

I don't usually think of sleepiness as directly due to diabetes, unless it's from uncontrolled hyperglycemia, and hence I am unwilling to suggest home remedies. There are also other conditions that are frequently associated with diabetes and which do have sleepiness as a symptom, and which your physician should check you for. Hypothyroidism is first on the list; other possible diabetes-related conditions would include sleep apnea, depression, medication side effects, heart disease, and kidney disease.

  • Doctor said I have bronzing on my lower legs; can this be controlled? I'm type 2 diabetic; lower legs are turning brown from calf to feet.

There are multiple causes for skin discoloration, and fortunately it is usually not a sign of a serious medical condition. In the location you describe, on your lower legs, it seems unlikely to be due to serious illnesses such as Addison's disease or hemochromatosis. I'd suspect from your description that it might be due to chronic venous insufficiency (CVI), with extravasation of red blood cells into the tissues and their subsequent breakdown into hemosiderin (which is a brownish-colored pigment) -- frequently seen in the lower calves and ankles of patients with CVI.

Over-the-counter creams are available for lightening the skin. If you are considering using these creams, follow instructions carefully. Check with your physician first. See Skin - abnormally dark or light for additional thoughts.

  • Can I use ACE inhibitors as a prophylaxis for diabetic neuropathy? Are there any risks associated with taking an ACE inhibitor for a way to prevent or delay diabetic complications even when I don't have any complications?

The use of ACE inhibitors (angiotensin converting enzyme inhibitors),  which are a class of prescription medications for treatment of hypertension, is routinely recommended for people with diabetes and hypertension (high blood pressure), especially for those PWD who also have protein (albumin) in the urine, as ACE inhibitors  help slow down the progression of diabetic kidney damage (nephropathy). There's also some studies showing that ACE-Is will help prevent diabetic neuropathy (nerve damage).

ACE side effects include (among others) low blood pressure, angioedema (which is rapid and sometime life-threatening swelling of the skin and subcutaneous tissues), nagging chronic cough, and for women using them during pregnancy, increased risk of birth defects.

Taking prescription drugs, especially in the absence of proven disease, is always a balance of benefit vs. risk (and cost!). ACE inhibitors are frequently recommended if a diabetic patient has hypertension, to prevent kidney problems (nephropathy).

But use of any ACE inhibitor to prevent diabetic neuropathy (nerve damage) is "off-label" - that is, there's not enough accumulated information to tell if it's safe and effective. I wouldn't advise such use unless in the setting of a clinical trial, where you give informed consent to participate.

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