by: daniel pearce, d.o., facoi, aahivms

A great study showed that doxycycline twice a day for 7 days cured more rectal chlamydia in men who have sex with men than the one-time dose of azithromycin. Because of rising resistance, the newest guidelines this year changed the gonorrhea treatment to double the dose of the injection (ceftriaxone) and changed the azithromycin to doxycycline. In addition, if a person has gonorrhea of the throat, they want a repeat throat culture a month later. Remember that most of these infections have no symptoms–no pain, no sensation, no drip or discharge.

Acid reducing drugs like omeprazole (and probably any drug that ends with –prazole) has been shown to decrease the Hemoglobin A1C by 0.36% which is a good amount.

The A1C is the measure of the average sugar over the last 3 months and is a pillar in diabetic management. The lower it is the less complications the patient has. We used to try to get it close to normal or 6 but there were so many low blood sugar (hypoglycemic) episodes that the guidelines now advise us to get it near 7.
If a diabetic patient is gaining weight and is not interested in following lifestyle changes then I rate their interest in living longer and postponing suffering as a D. An A patient is one who follows their diabetes education closely and is at or getting to their best weight. The D patients will gain weight if we put them on more medications or insulin causing the sugars to rise along with the weight. So we increase the medications and they gain more weight. We try to avoid this vicious cycle.
There are many pills out there for diabetes and metformin is the best and baseline medication. We try to get all our diabetics on 1000mg twice a day or 2000mg of the long acting one a day (if insurance will cover it). Then we add a pill or two but if we can’t control the sugar at this level along with lifestyle changes many of us go to insulin instead of more pills. The pills are weak compared to insulin. But there are patients with weak diabetes and strong diabetes so we match the medications to the patients.

Usually we don’t need 4 blood sugar checks a day. When things are stable and there are no dosing or dietary changes, 2 fasting and 2 other blood sugar checks a week are sufficient. Of course, if a patient is not eating due to illness, then I ask them to cut their meds in half. They still need the medications, just less. And then they should check their glucose before each meal and at bedtime, i.e. four times a day.

There are two things that lower glucose, medication and exercise. So you see that exercise has an immediate beneficial and long-term effect on the sugar metabolism. Food is the only thing that raises sugar. We must balance all three to achieve good control to give the patient good mental and physical energy.
If diabetes is not controlled well then the complications happen sooner: kidney failure needing dialysis, impotence, heart attacks and strokes, poor healing of wounds and amputations, nerve pain in the feet and hands, loss of sight to name a few.

For kidney failure, life on dialysis is not fun but it beats dying. Your energy levels cycle from moderate to poor. Peritoneal dialysis works with you running fluid into a catheter in your abdomen to make it swell, and then draining it a few nights a week to daily. There is a lot of equipment at home. Hemodialysis is once to 3 times a week at a center where they put a large bore needle into a graft under your skin or a large bore catheter inserted into your upper chest to filter the blood for a few hours. Counting transportation, it can take many hours to complete the dialysis process.

Obviously preventing diabetes is way superior to treating it. Following a healthy lifestyle is key from an early age. Many children are not following a healthy lifestyle and now have diabetes.

Gastric surgeries for obesity can help diabetes but they need a special diet much of their lives and may have bowel problems. After they lose weight, they may have floppy skin that will look better after a surgeon removes it.

We are fixated on cure and treatment in this country instead of prevention. How sad.

Please take care of yourself. It is not a great hardship to eat healthfully and exercise. The benefits far outweigh the costs.

Keep those questions coming and be safe!

Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine HIV, Hepatitis B,C, Transgender, Suboxone Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto) Member, Coachella Valley Clinical Research Initiative