Dear Dr. Roach • I just wanted to touch base with you about my diabetes. While my weight has stayed stable around 320 pounds, my sugar numbers have been increasingly hard to keep in line. I’ve maxed out on the oral medications we use. My latest A1c was 6.6. The doctor says it should be under 6 and that our next step is insulin. He asked me to try to lose 50 pounds over the next six months in order to get my sugar back under control.
I agree and want it to happen. I’m counting calories and cutting out carbs, and have started walking in the morning. I know I can’t run, with no discs in my bottom three vertebrae. But even walking is hard. I walk until my leg goes numb, but I don’t think it will be enough, and I may not even be able to keep that up. Even walking easy makes my hip hurt and leg go numb after about 20 minutes. — S.A.
Answer • I am surprised by your doctor’s advice, because it’s very clear now (from the ACCORD study) that an A1c (a measure of average sugar levels) of 7 percent has lower overall risks than an A1c of 6 percent for someone like you.
Exercise is always good, and my first thought is water. Getting in a pool will take pressure off your back, and you should be able to swim, walk in the water or do water-exercise classes to your heart’s content.
Dear Dr. Roach • I read a letter that seems to be saying that the Department of Health and Human Services is against breast-feeding. There also was something about hospitals and insurance companies, but I’m not sure what that was all about. Up until now, I just thought that breast-feeding was the best I could do for my baby. But if that’s true, then why would the DHHS or hospitals be against breast-feeding? — S.G.
Answer • There is no doubt that breast-feeding is best for your baby. Breast-fed babies have lower risk of becoming overweight and of many illnesses. The science is absolutely clear.
I read the letter I think you are referring to, and it seems to me that it is pointing out that some hospitals don’t do as good a job as they could in helping educate new mothers about why and how to breast-feed. According to the Centers for Disease Control and Prevention, without hospital support, one in three mothers stops breast-feeding. Only about 5 percent of babies are born in U.S. hospitals that are designated “baby-friendly.” I support initiatives that help promote breast-feeding in hospitals, and hope the DHHS gives its support as well.
Dear Dr. Roach • I just read today’s column regarding the shingles vaccine. I am an insurance agent who is often asked about coverage for the shingles vaccine. The Affordable Care Act does include this under preventive care for individuals 60 and over. Preventive care is covered at 100 percent for health plans that are not grandfathered. (Grandfathered health plans are plans that have been continued virtually unchanged since 2010. They are not required to comply with all aspects of ACA, so these plans might not provide this service.)
You also may be interested in knowing that, in our area, the Department of Health clinic does offer the shingles vaccine for a fee of $5 for individuals over the age of 50 who do not have it covered under a health plan. I am not aware if this is unique to our area, or if it is a widespread provision.
Answer • Thank you for writing in. Others wrote to me that their Department of Health paid for most or all of the cost. Some said they could get the vaccine covered at a pharmacy but not at physician’s offices.
Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital.Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475
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