Doc: Lifestyle changes are effective against diabetes
Dear Dr. Roach: My mom is a poster child for diabetes prevention. She was born in 1921. Her dad supposedly developed Type 1 diabetes about 20 years earlier. He had to use diet and exercise to survive, since insulin was not yet developed. (I suspect that it might not have been Type 1, because I don’t think he could survive that long without insulin.)
Anyway, her dad had diabetes of some type, even though he was thin and active. Her mom developed Type 2, as did all five of her siblings. My mom grew up on a very strict diet (low carbs, desserts very infrequently, etc.).
As an adult, she continued with this spartan diet. Even with her grim genetic makeup, she did not become prediabetic until she was 83, and then only when she was hospitalized and could not exercise. At 96, she is still in that borderline range, controlling her blood sugars with diet and as much exercise as she can manage.
Please share this with people who need evidence that a careful diet and daily exercise make a difference, even in a person with a significant genetic predisposition for diabetes.
Dear L.S.: I thank L.S. for writing. I also have seen people whose siblings and parents were diabetic keep diabetes away by a very careful (but not unenjoyable) diet and regular exercise. As physicians, I think we sometimes rush to medications when more education and motivation might get people to control (or prevent) diabetes through lifestyle.
I do know that, prior to isolation of insulin, careful diet and exercise regimens did allow some people with Type 1 diabetes to live long enough to be successfully treated with insulin once it became available. However, Type 1 diabetes was indeed a death sentence for the vast majority of people before Banting, Best and Macleod in Toronto isolated insulin in 1922.
Although some people with Type 2 diabetes can do everything right and still require medication, most people can greatly reduce or eliminate the need for medication.
Dear Dr. Roach: About a month ago, out of nowhere, my penis developed a severe curvature. I did not have any traumatic incident down there. I also have experienced some reduction in length and girth. I did some research, and some of the literature said that it may cure itself, while some said surgery is the only option. I am a little over 60 and want to remain active. Is there any option besides surgery?
Dear G.H.: Peyronie’s disease is a common (about 5 percent of men) acquired condition of fibrosis and scarring of the penis, specifically the tunica albuginea, a strong layer of connective tissue of the penis. It can be related to trauma, even mild trauma, but the problem is in excessive healing causing a fibrous plaque, which reduces elasticity and thus causes a palpable plaque and bending of the penis while erect.
There is medical treatment available, although it is not extremely effective. The usual first-line medication is pentoxifylline (it’s not clear exactly how the drug works in this condition). It normally is given to people with more than mild symptoms (which only occasionally go away by themselves). I would seek attention soon, as treatment is more likely to be effective when started early. A urologist would be the best person to see if your regular provider isn’t experienced in treating this condition (most of us primary care doctors aren’t, but some certainly are). Surgery is reserved for people who do not respond to medical treatment.
Email questions to ToYourGoodHealth@med.cornell.edu.