Answered by: Dr. Mariela Glandt

Based on the information you’ve provided, it doesn’t sound like you have an urgent need for medication, however, it is always best to consult with your personal physician for a correct assessment.  It is of great importance that you stick to your diet and exercise plan, and continue to monitor your blood sugar, as you have been.

Answered by: Dr. Mariela Glandt

It is wonderful you lost so much weight! Congratulations!

While liraglutide helps to increase insulin after the meals, it seems it is not enough in your case.  If the post meal spike is not too bad, you could ask your doctor about trying repaglinide (Prandin) or nateglinide (Starlix) with meals, which also lower blood glucose by stimulating the release of insulin from the pancreas. Any sulfonylurea should also help. These options are worth considering before you jump to insulin, since they might give you the extra insulin push, at least for a while.

Answered by: Dr. Mariela Glandt

The tingling in your daughter’s feet is most likely due to the high sugars she had been experiencing before she was diagnosed with diabetes. Fortunately, this should resolve once her sugars become controlled.  These symptoms are not related to the complication of diabetes referred to as “diabetic
neuropathy”.

Diabetic neuropathy usually presents after many years of high sugars. Large studies, such as the Diabetes Control and Complications Trial, have shown that controlling the sugars can greatly decrease the chances of developing neuropathy.
She should continue to exercise and to control her sugars as much as possible.  For vegetarians, it’s also important to check vitamin B12 levels. As long as your daughter follows up regularly with a doctor, she should enjoy life and not worry about the complications of diabetes.

Answered by: Dr. Mariela Glandt

Most of the risk that comes from eating too many sweets is associated with fact that eating a lot of sugar leads to weight gain, which in turn can lead to diabetes.  Having said that, there are studies that show, for example, that if you drink more than 2 soft drinks a day you are at increased risk of developing diabetes, regardless of the amount of weight gain.

When we say that type 2 diabetes is caused by genetics and lifestyle factors, it is in a way saying yes, there is a predetermined level of insulin production.  There are those lucky people who eat lots of sweets, but somehow their pancreas can compensate for this by producing more insulin, and hence keeping the sugars in the normal range. While there are others whose pancreas cannot respond to that kind of stress, and thus cannot produce enough insulin, and their blood sugar levels go up.  This is indeed preset mostly by genetic factors, and perhaps also by circumstances set in the mother’s womb.  If you have a history of diabetes in your family, try not to stress your pancreas too much! Keep to a healthy diet and exercise.

Answered by: Dr. Mariela Glandt

One of metformin’s very rare side effects is that it can cause lactic acidosis. Although rare, lactic acidosis is potentially a very severe, even fatal,side effect mostly related to kidney function.
If the liver is not working well, this is also a reason not to take metform since it could also make you more prone to lactic acidosis.Because drinking excessive alcohol at one time, or drinking hard drinks on a regular basis can harm your liver, it is not recommended. A hard drink once a week seems acceptable, but consult your physician for his/her recommendation.

Answered by: Dr. Mariela Glandt

There is definite rationale in what your doctor suggested, it’s just very difficult to do.  We as a society are intoxicated with carbohydrates. If you think about the fact that rice, potatoes, and bread are actually a very recent addition to the human diet, it starts to make sense. For millions of years humans were hunters and gatherers, and ate mostly meats, nuts, and fruits.  Only recently (10,000 years or so ago) with the advent of agriculture, did they start making carbohydrates a large part of the diet.  We are supposed to eat carbs, yes, but at much, much lower quantities than what we encounter in our current diet. Try eating much smaller portions, substituting rice with a salad, and don’t drink any soft drinks–ever! (that is just liquid candy).  Soon you will be amazed at how well you are doing without large quantities of carbohydrates. This will make it a lot easier to lose weight, too, and that in itself might make the insulin resistance much better.