DEAR DR. ROACH: Why do commercials for diabetes show most people who need medication as overweight? I know slim people who have this problem. — R.J.
ANSWER: There are several different types of diabetes mellitus (“diabetes” is from the Greek root word meaning “to go through,” referring to the excess urination in people with high blood sugars, while “mellitus” means “sweet”), differentiating it from diabetes insipidus. (“Insipidus” means tasteless. I’m very glad laboratory analysis has replaced tasting.)
The most common type in adults, Type 2 diabetes, is much more common in people who are overweight or obese. About 90% of adults with Type 2 diabetes are overweight or obese. Insulin resistance, the hallmark of Type 2 diabetes, is greatly increased in overweight people. People who are not overweight with diabetes can have several different problems, including Type 1 diabetes (an autoimmune disease where the insulin-producing cells are attacked); antibodies to the insulin receptor; monogenic diabetes (formerly “maturity onset diabetes of the young,” with six known genetic variants). There are even rarer causes of diabetes mellitus, some of which are likely in lean or even underweight people.
Commercials are designed to make people identify with the actors, but cannot reflect the tremendous diversity of people with diabetes.DEAR DR. ROACH: I am a 79-year-old female. I am in generally good health, but have a question about RhoGAM. When I had my children in the ‘60s, I was in the original study conducted to see if my AB negative blood type would hurt my children. I understand that the Rh factor can hurt unborn babies.
Was there ever a follow-up study about us? Was there anything different about our health as we grew older? — R.J.
ANSWER: When a mother has the Rh-negative blood type and the father is Rh-positive, there is the potential of immunizing the mother against the blood of her developing baby. Anti-D immunoglobulin (RhoGAM) is given to reduce the risk of this happening.
Although I see many news reports about putative effects of blood type, there are few conditions where Rh factor (or even the ABO blood type) consistently makes a significant difference for risk of any disease.
Many studies have been done with no clear evidence that people with Rh-negative blood are at increased risk for chronic medical issues. AB negative is the rarest blood type to have, but that’s not a bad thing.
DEAR DR. ROACH: I take several prescribed medications every morning, together with over-the-counter supplements. Because I have a difficult time swallowing pills, it was suggested that I use a pill crusher (for pills that the pharmacist deems OK to crush) and to mix the crushed pills with a little applesauce (1-2 tablespoons).
It works great, but I have to wonder, is there anything taken away from the full effectiveness of all the pills, including instant interactions, when they form a powder? — E.R.
ANSWER: Generally not. Drug companies take the powdered drug and squeeze it together into a pill to make it easier to take, but it’s not inherently better than taking it as a powder. As you say, you need to check with the pharmacist. Some pills are designed to release medicine slowly, and that ability is lost when you crush it.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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