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This week we respond to questions about diabetes and gout.

Dear HOUSE Calls,    

I have diabetes and my blood sugar has been running high – around 230. I was on medication that was working. Why is it not working anymore? I don’t want to go on insulin.

Insulin resistance, the primary cause of Type 2 diabetes, gets worse over time. Even if you are well controlled and maintain your diet and activity level, there is some chance you will need more medicine over time.

Also, there is a class of medicines that stimulates the pancreas to make more insulin (e.g. glipizide and gliperamide). Apparently, the pancreas seems to fatigue of being in overdrive after awhile. For some people these medicines loose effect after about 5 years.

There are now 5 classes of oral medicines on the market that are for diabetes.  Each of these medicines has a different profile in terms of action, effect, side effects, and adverse reactions. Not knowing any more about your situation, we can’t make any particular recommendations other than talk to your doctor.

As far as insulin, we would first off wonder why you are opposed to insulin. Is it the mere act of giving yourself a shot? There is another diabetes shot that is not insulin that you could consider as well. Insulin does have a high risk of low blood sugars or hypoglycemia, and it is also associated with weight gain or making weight loss harder. We would encourage you to think about where you might improve your diet and/or increase your exercise to see if you can avoid additional medicines. Good luck.

Dear HOUSE Calls,    

I have lots of pain in my knees and my doctor said I have gout. I had my uric acid tested and it was normal. I thought uric acid was high in gout. Do you think I have gout?

That is a great question. First we would say that there are many things that cause knee pain, and osteoarthritis is chief among them.

There are other types of inflammatory problems, like rheumatoid arthritis, which are less common. The knees are an unusual joint for gout. In addition, gout does not usually flare in non-continuous joints at the same time.

The normal uric acid level makes gout somewhat less likely as the culprit as well, however, during a flare, if the uric acid has crystallized in the joint, the blood level may be normal.

The best way to diagnose gout is to get a sample of joint fluid and look for uric acid crystals with a certain type of microscope. It is important to confirm the correct diagnosis so that you can get proper treatment.

HOUSE Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page, and Dr. Adam Zolotor on behalf of YOUR HEALTH and the UNC Department of Family Medicine.

Physicians from the UNC Department of Family Medicine’s YOUR HEALTH media bring you weekly information in response to your questions about health and medicine. Send us your questions or comments to  YOURHEALTH@unc.edu

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