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Dear Dr. Roach: My elderly sister, 73, has Type 2 diabetes, and is taking 500 mg of metformin twice a day.

After two years on metformin, her fasting glucose level is only 125 mg/dl and A1C only 6.8 percent. If she continues taking medication, will her fasting glucose level ever get to around 85 mg/dl and her A1C get to 5 percent? She wants to be in the normal ranges.

In your opinion, is the goal of drug therapy, like metformin, only the control of diabetes? If so, then what can she do to reach her goals of 85 mg/dl and A1C of 5 percent?

R.I.

Dear R.I.: Type 2 diabetes mellitus is a common disorder of unknown exact cause, but which generally is caused by resistance to the action of insulin and by a gradual decrease in the amount of insulin the pancreas is able to put out.

There are many types of treatment for diabetes, but the most important are a healthy diet and regular exercise (a registered dietician nutritionist is a valuable source of information).

In people who need medication, metformin is a very good first choice for many, especially people who are overweight.

The goal of treatment is the control of symptoms, but also to reduce the risk of complications of diabetes, especially blood vessel disease. Small blood vessel disease leads to kidney failure, nerve damage and vision changes. Large blood vessel disease leads to heart attack, stroke and peripheral vascular disease, which sometimes can mean amputations.

There remains debate about the optimal blood sugar goal. For older people and those at high risk for (or who already have) large blood vessel disease, treating people with a goal A1C level of 5 percent actually has more risk than a goal of around 7 percent.

However, for younger people, most diabetes experts recommend an A1C level in the “normal” range, such as 5 to 6 percent. Achieving that requires dedication, meticulous care of diet and exercise, and often multiple medications.

Dear Dr. Roach: I am drinking almond milk and orange juice that is fortified with calcium and vitamin D to try to get my daily requirements of these vitamins. Sometimes I use the milk in my instant Cream of Wheat or oatmeal, and wonder if heating these vitamins in the microwave or stovetop destroys their potency.

D.L.

Dear D.L.: Calcium is very stable and won’t be damaged by heating, freezing or really anything you do to it. Vitamin D also is relatively stable: Oven-baking foods with vitamin D can destroy about half the vitamin, but brief heating does very little damage to vitamin D.

Other vitamins are not so stable. Vitamin C in particular is very sensitive: Brief cooking or even sitting around on a shelf (such as canned vitamin C-enriched drinks) can degrade most or all the vitamin C. That’s one of the reasons to eat fresh, raw fruits and vegetables as part of your diet.

Other nutrients are paradoxical: lycopene (a micronutrient found in tomatoes) is concentrated by cooking, so ketchup and tomato sauce and paste are the leading sources of this nutrient in the U.S.

Email questions to ToYourGoodHealth@med.cornell.edu.

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