DEAR DR. ROACH: Why do commercials for diabetes show most people who need medication as overweight? I know slim people who have this problem. —R.J.
ANSWER: There are several different types of diabetes mellitus (“diabetes” is from the Greek root word meaning “to go through,” referring to the excess urination in people with high blood sugars, while “mellitus” means “sweet”), differentiating it from diabetes insipidus. (“Insipidus” means tasteless. I’m very glad laboratory analysis has replaced tasting.)
The most common type in adults, Type 2 diabetes, is much more common in people who are overweight or obese. About 90% of adults with Type 2 diabetes are overweight or obese. Insulin resistance, the hallmark of Type 2 diabetes, is greatly increased in overweight people. People who are not overweight with diabetes can have several different problems, including Type 1 diabetes (an autoimmune disease where the insulin-producing cells are attacked); antibodies to the insulin receptor; monogenic diabetes (formerly “maturity onset diabetes of the young,” with six known genetic variants). There are even rarer causes of diabetes mellitus, some of which are likely in lean or even underweight people.
Commercials are designed to make people identify with the actors, but cannot reflect the tremendous diversity of people with diabetes.
DEAR DR. ROACH: I take several prescribed medications every morning, together with over-the-counter supplements. Because I have a difficult time swallowing pills, it was suggested that I use a pill crusher (for pills that the pharmacist deems OK to crush) and to mix the crushed pills with a little applesauce (1-2 tablespoons).
It works great, but I have to wonder, is there anything taken away from the full effectiveness of all the pills, including instant interactions, when they form a powder? — E.R.
ANSWER: Generally not. Drug companies take the powdered drug and squeeze it together into a pill to make it easier to take, but it’s not inherently better than taking it as a powder. As you say, you need to check with the pharmacist. Some pills are designed to release medicine slowly, and that ability is lost when you crush it.
