Dear Dr. Eva,
I have a question about insulin dosing. I am a middle-aged man with diabetes type two for about seven years now. I took pills at first but soon needed insulin. I now take 120 units of insulin a day with reasonably good control of my blood sugar. As far as I know, I’ve never had a problem with low blood sugar.
Here’s the question. I have an 18-year-old niece who was found to have type 2 diabetes at age eight. Even though she has been diabetic for ten years, she only takes 24 units daily. She suffers from frequent hypoglycemia episodes. Although we are both diabetic, it seems almost as if we have totally different conditions. Can you shed some light on this?
Dear Type 2,
You are exactly right! Even though both of you have diseases of blood sugar regulation, you and your niece have different conditions.
Diabetes type 1 is a disease of insulin deficiency. The cells in the pancreas, where insulin is produced, lose the ability to produce it. Within the first year of the disease, most people cannot produce any insulin. The only treatment is insulin injections. Type 1 diabetics are very sensitive to insulin and can easily develop low blood sugar if they miss a meal or exercise more than usual without decreasing their insulin dose. Diabetes type 1 is not inherited, that is, it does not run in families.
Type 2 diabetes is mainly a disease of insulin resistance. Although the body continues to produce insulin, it loses the ability to absorb it into cells and use it normally. Initial treatments for type 2 diabetes are oral medicines (pills) that work either by stimulating the pancreas to make more insulin or by increasing insulin sensitivity. It may be five years or longer before the pancreas completely stops producing insulin. After that point, insulin is the main treatment. Because of insulin resistance, much more insulin is required to control type 2 than type 1 diabetes. The tendency to develop type 2 diabetes is inherited.
Dear Dr. Eva,
I am a 23-year-old woman with a really embarrassing problem. I sweat heavily from the palms of my hands and the soles of my feet. It started in my late teens. It happens all the time and gets worse when I’m nervous or anxious. I am a recent college graduate. In college I could avoid shaking hands with people most of the time, but in the business world it can’t be avoided. Is there something over-the-counter that works for this? I won’t qualify for health insurance until I pass my six-months’ probation.
Excessive sweating is a problem that, unfair as it is, can have a negative effect on the way people perceive you, socially and at work. Fortunately, there is effective treatment available without a prescription, at a pharmacy or mail order through Amazon or other on-line shopping companies. Look for products containing aluminum zirconium tetrachlorhydrate or trichlorhydrate, 18 or 20 gm aluminum zirconium per 100 gm of the product. On the label, this looks like “20gm / 100 gm.” These preparations are often labeled “clinical strength,” but you should check the ingredients before buying because not all antiperspirants so labeled contain aluminum zirconium, and of those that do, the concentration is often not high enough to be effective. These are a few antiperspirant brands that have 20 gm aluminum zirconium per 100 gm product: Certain Dri, Axe, Brut, Code Blu Scent Elimination, Degree Clinical Protection. There are many others as well.
To get the best effect from these products, apply to dry skin (palms and soles) at bedtime. If necessary, use a blow dryer to dry the skin. Do not apply to broken, irritated, or recently shaved skin. Wash off in the morning, then use your usual antiperspirant. As the sweating decreases, decrease the dose frequency gradually to once a week.
If this is not effective enough, when you are able to get medical care you will have several options, usually tried in this order:
1) Drysol (20% aluminum chloride), a prescription antiperspirant similar to the over-the-counter products but a little stronger and more irritating to the skin.
2) Iontophoresis, which is using a mild electric current to pass water through the skin. It is painful and can be done at home. It is unknown how or why this works.
3) Botulinum toxin injections, the same treatment (Botox) used to get rid of wrinkles.
Meanwhile, keep a handkerchief in your pocket to dry your palms before shaking hands. Otherwise, try to ignore the sweaty palms as much as you can. The less attention you pay to the problem, the less others will notice it.
- Eva Hersh is a family physician. Send your comments and questions to her by email at firstname.lastname@example.org
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