Dr. Keith Roach
Pricey Dr. Roach: My query regards the outcomes of my fasting glucose assessments for the previous couple of years. I’m 81 and weigh round 150 kilos. The medicines I’m taking concern me, with relevance to the A1C ranges of my quarterly blood work. My A1C ranges have largely been close to mid 5%; final was 6%. Medicines related to this that I’m suspicious of are 100-12.5 mg of losartan/hydrochlorothiazide (HCTZ) and 20 mg of simvastatin. I’ve learn that these medicines can have an impact of elevating blood glucose. My physician is adamant that this doesn’t exist, nevertheless it appears to me that there’s a battle on this.
Ought to I maybe ask him to vary these medicines due to blood sugar? I’m involved about points with the thiazide and the statin.
— P.R.
Pricey P.R.: There isn’t a battle. You’re completely proper that each simvastatin (like all statins) and HCTZ (like all thiazides) enhance blood sugar and the danger of diabetes. The chance, nevertheless, is small. For thiazides, the danger of excessive blood sugar appears tied to potassium ranges – the decrease the potassium, the upper the danger of diabetes. Curiously, the losartan that’s together with the HCTZ you’re taking tends to boost potassium ranges, in order that mixture could have a decrease danger of worsening blood sugar ranges than taking HCTZ alone. You’re already taking the smallest efficient dose of thiazide.
The chance of statins appears better in larger doses and with stronger statins, like atorvastatin and rosuvastatin; nevertheless, the danger remains to be small. About one particular person in 100 handled with a high-dose intensive statin, resembling 40 mg of atorvastatin for 5 years, could be anticipated to get diabetes, whereas a dosage of 20 mg of simvastatin could be anticipated to have an excellent decrease danger.
The battle isn’t whether or not the elevated danger exists (it does), however whether or not the therapies to stop coronary heart assault and stroke are definitely worth the elevated danger. For practically all folks, the advantage of protecting blood stress and ldl cholesterol beneath management vastly outweighs the small elevated danger of diabetes.
Given your regular A1C degree, I’d say your danger is low, and I don’t typically advocate altering therapy primarily based in your concern over blood sugar.
Pricey Dr. Roach: I’m a 64-year-old man who not too long ago had an ultrasound of my kidney to rule out any kidney stones. The utlrasound was destructive for stones, however the radiologist famous a 2.3-cm echogenic nodule in the precise lobe of my liver. The ultimate impression was an incidental hemangioma within the liver. I used to be involved, so I acquired an AFP (alfa-fetoprotein) take a look at, which got here again at 1.8 ng/mL.
Is an echogenic nodule/incidental hemangioma a motive to have additional testing?
— M.S.
Pricey M.S.: Delicate imaging research, particularly CT scans and MRIs, typically reveal abnormalities that result in a quandary of whether or not to get extra testing. For a mass discovered within the liver by ultrasound, whether it is lower than 3 cm and meets the radiologic standards for a hemangioma, no additional testing must be carried out in folks at low danger for liver most cancers (resembling folks with hepatitis C or cirrhosis). So long as these trigger no signs, they don’t get handled.
The alfa-fetoprotein take a look at is a blood take a look at that, when producing abnormally excessive outcomes, helps signify a number of kinds of cancers, together with hepatocellular carcinoma (basic liver most cancers) in addition to germ cell tumors (cancers of the reproductive cells, which normally happen within the gonads however can happen within the liver or elsewhere within the physique). Your degree is regular and never regarding.
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