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Dr. Daniel Spogen answers the question: “How can I manage my type 2 diabetes?”

Type 2 diabetes is a chronic condition that affects how your body metabolizes sugar, or glucose, your body’s main source of fuel. Type 2 diabetes afflict many people in Nevada and the number of new cases is reaching epidemic proportions according to the Centers for Disease Control. The good news is that, in most cases, the disease is preventable.

But what if your family physician or internist diagnosed you with type 2 diabetes? It means your body is resistant to the effects of insulin. Insulin is a hormone that regulates how sugar is absorb into your cells. Having type 2 diabetes means your body doesn’t produce enough insulin to maintain normal glucose levels. There’s no cure, but if you’re diagnosed with type 2 diabetes, it can be managed. Eating healthy foods, engaging in regular physical activity and maintaining a healthy weight are key.

Our nutritionists in Las Vegas or Reno are experts who can work with you to develop a personalized diet that works for you. Generally speaking, an ideal diet is one that consists of two thirds fruits, vegetables and grains. The remaining third can be most anything else, although avoiding simple sugars like certain fruit juices and candies, pasta, alcohol and animal fats is highly recommended. Making these simple changes will improve your type 2 diabetes, while helping you lose weight as well. As I tell my patients, it’s not how much you eat but what you eat that’s important. Daily physical activity like walking, jogging, biking and swimming, is also critical to control your type 2 diabetes. Following general exercise guidelines works well.

Your family physician or internist will want to manage and monitor several things after your diagnosis of type 2 diabetes, such as blood pressure, cholesterol levels and triglycerides. Your kidney function is also monitored to ensure its working properly. Blood pressure monitor is especially critical to managing type 2 diabetes. Type 2 diabetics don’t usually die of blood sugar but usually die from microvascular or macrovascular disease, the most common being a heart attack. The correlation’s so great that the risk of having a heart attack in someone with diabetes is the same as if you’ve already had a heart attack. So instead of aiming for a blood pressure reading of less than 140/90, the typical goal for the diabetic patient is a blood pressure reading of less than 130/80. Most doctors will start with a diuretic as the first line of defense in blood pressure control.

Cholesterol levels should be less than 200 mg/dL, with LDL, or low-density lipoprotien, levels less than 100 mg/dL. Some medical sources even suggest an LDL level of less than 70 mg/dL. Improving HDL, or high-density lipoprotein, levels, or what’s popularly called “good cholesterol,” is also important, but hard to do. HDL levels is most affected by a consistant exercise regiment.

Remember, a good, healthy diet and regular, daily exercise are the most important factors in controlling type 2 diabetes and the disease’s destructive effects on your body.

Daniel Spogen, M.D. was named chair of the family and community medicine department at the University of Nevada School of Medicine in Reno, Nevada in October 2006. Before joining the medical school’s faculty, Dr. Spogen was in private practice for more than 20 years in northern Nevada. He helped launch fellowship programs in obstetrics and sports medicine at the medical school as well as serves as assistant student clerkship director.

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Dr. Andra Prum answers the question: “How do I know if I have osteoporosis and how can I prevent it?”

The National Institute on Aging reports that more than 10 million Americans have osteoporosis and about 18 million have lost enough bone density to be susceptible to developing the disease. Most who are afflicted by the disease are women but men are also at risk. Osteoporosis causes our bones to become weak and brittle. In severe cases even mild bodily stress can cause a bone fracture. In most cases bones weaken when calcium, phosphorous and other minerals in our bones are at low levels.

How Do I Know if I Have Osteoporosis?

Osteoporosis generally doesn’t exhibit outward symptoms, so you may not know your bones are getting weaker. Osteoporosis is usually diagnosed with a bone mineral density test or DEXA scan, a special type of x-ray. Our bones are continuously changing. Our bodies replace old bone with new bone in a process called remodeling. It takes about two to three months for our bodies to complete a full cycle of bone remodeling. As we get older, your body’s process of bone remodeling continues but gradually slows, losing slightly more than it replaces.

For women, bone loss increases during menopause, when estrogen levels decrease, although there are other contributing factors. Generally speaking, if you’re older than 65, you should get a bone density test. If you’re 60 to 64 years old and weigh less than 154 pounds and don’t take estrogen, you should get a bone density test.

How Can I Prevent Osteoporosis?

There are steps you can take to protect your bones. Exercise and a healthy diet are important in reducing your risk of developing osteoporosis. Physical activity, in particular weight training, is important to helping develop stronger bones, although patients with osteoporosis should consult with their doctor. In regards to food, dairy provides a rich source of calcium essential for building and maintaining strong bones. Vitamin D helps your body absorb calcium.

Postmenopausal women on hormone therapy should consume at least 1200mg of calcium and 400-800IU of vitamin D a day. Postmenopausal women who are not on hormone therapy and men and women over 65 years old should take 1500mg of calcium and about 800IU of vitamin D a day. Researchers are studying vitamin D to determine the optimal daily dose.

Hormone therapy was once the standard treatment for osteoporosis in women. However, concerns about safety and other treatment options have reduced the role of hormone therapy in managing osteoporosis. Other treatments include bisphosphonates, calcitonin, parathyroid hormone and selective estrogen modulators. You should discuss your options with your family physician, internist or bone health specialist to determine the best treatment.

Osteoporosis and Men

It’s important to note that even though women are four times more likely than men to develop osteoporosis, more than two million men in the U.S. are affected, according to the National Osteoporosis Foundation. Bone loss in men develops more slowly. The National Institutes of Health calls the problem of osteoporosis in men an important health issue since it’s estimated that the number of men above age 70 will double between now and 2050.

Each year, men suffer a third of hip fractures and a third of those men will not survive more than one year. Bone loss in men can be a simple result of gradual, age related bone loss, low testosterone, and medications such as prednisone that can lead to steroid excess.

Andra Prum, D.O. is an assistant professor of family and community medicine at the University of Nevada School of Medicine. She practices at the school’s Family Medicine Clinic in Las Vegas.

Have a question? University Health System doctors answer select questions from readers like you.