Ask the Doc: Your questions answered about Endocrinology.

By Guest Editor on Aug 3, 2016

As you age, your primary care provider may recommend that you go see an endocrinologist for solutions to some chronic health problems. Endocrinologists treat and diagnose hormone imbalances or hormone-related conditions such as diabetes and hypertension that can occur at any stage of life, especially those that arise with age. Here are responses to commonly asked questions from WellHealth Medical Group's Endocrinologist, Dr. Paul Tomasic.

Question: Does being diagnosed with type 2 diabetes mean I will have to go on insulin?

Dr. Tomasic: A diagnosis of type 2 diabetes does not necessarily mean having to go on insulin. The foundation of treatment is diet and exercise. Most commonly, oral medications are added next. If one, two, or three oral medications do not control the blood sugar levels, injectable medications are usually added to a patient’s treatment plan.  There are potent injectable medications called GLP-1 agonists that are often given before insulin. If none of the previous options are effective in controlling blood sugar, insulin is then added to the regimen.

Question:  How do my hormones affect my bone density? 

Dr. Tomasic: In women, estrogen acts as an anti-resorptive (anti-bone loss) agent. After menopause, the rate of bone loss that occurs with normal aging will accelerate with the decrease in estrogen. Similarly in men, a significant decrease in testosterone (hypogonadism) may also lead to an accelerated rate of bone loss.

Question: What is a normal blood pressure and how can I maintain it?

Dr. Tomasic: A blood pressure of 120/80 mm Hg is generally regarded as a normal blood pressure. However, blood pressure in the gray area of 120-139/80-89 mm Hg can be categorized as prehypertension. Because prehypertension can progress to hypertension in 50 percent of patients over four years, even  low-risk prehypertensive patients should be monitored annually. Measures that can reduce the risk of developing hypertension include losing weight if obese, treating sleep apnea if present, decreasing salt intake if it is elevated, limiting alcohol to no more than two drinks daily, quitting smoking if a smoker, avoiding NSAIDs if possible, and maintaining an adequate potassium intake.

Question: I'm at risk for diabetes, what steps can I take to reduce my chances of developing diabetes?

Dr. Tomasic: Lifestyle changes, diet, and exercise are the best measures to reduce the risk of progression to diabetes. If prediabetic, the best scientifically proven way to prevent progression to diabetes is to enroll in a 16-week CDC approved Diabetes Prevention Program (DPP) that teaches healthy eating, achieves weight loss, and incorporates exercise. Medications such as metformin are often used for diabetes prevention in  prediabetes, but the data shows that the formal DPP has better results.

Question:  Can I get rid of diabetes if I stop eating carbohydrates and/or lose weight?

Dr. Tomasic:  Type 2 diabetics can sometimes control blood sugar levels with diet and exercise only.  Weight loss is a key factor in most type 2 diabetics trying to control blood sugar levels. I do not advise stopping carbohydrates altogether. Appropriate portions of carbohydrates, fat, and protein are important in having a balanced diet. Working with a dietician can be very important to learn how to eat a balanced diet that incorporates an appropriate amount of carbohydrates.

If you are currently experiencing any of these symptoms, or other conditions that are affecting your quality of life, make an appointment to talk with your preferred provider.