Saturday, 22 October 2011
Is it Heartburn or Something Else? How to Tell the Difference


One common symptom of gastroesophageal reflux disease (GERD) is heartburn-like pain. But a number of other conditions can cause that burning feeling in your chest.

Most often, your family doctor will be able to identify whether you have heartburn or GERD by doing simple tests.

Nine other conditions that can cause heartburn-like pain

  • Angina-- chest pain caused by lack of blood flow to the heart, can feel a lot like heartburn.

The biggest clue is if you get heartburn when you are doing strenuous or moderate activity. 

Also if you are over age 50 and get heartburn—especially if you have never had this kind of pain before—increases suspicion of angina. Suspicions are also raised for those who are younger but have heart risk factors such as hypertension, diabetes, or a family history of heart disease

  •  Gallstones-- a stone blocking your bile duct can cause pain,normally in the middle or upper-right side of the abdomen. Pain may be cramping, dull, or sharp, and often happens minutes after you eat.

If you have stomach pain after meals that doesn't get better after you take an over-the-counter acid-suppressing medication, gallstones should be suspected.

  • Ulcers-- cause a gnawing, burning sensation, usually felt in the upper abdomen. The pain can radiate up to the chest.

Acid-suppressing medications may help ulcer pain, but ulcers are most often caused by Helicobacter pylori, also known as H. Pylori, a bacteria that inflames the stomach lining, so you will need to see your family doctor and take antibiotics to clear the infection.

  • Hiatal Hernia-- happens when part of the upper stomach pushes through the diaphragm into the chest cavity, rather than staying in the abdomen where it belongs.

This condition pushes food and stomach acid up into the esophagus, causing heartburn. Other symptoms of hiatal hernia include chest pain, belching, and nausea. Your family doctor will typically prescribe acid-suppressing drugs, and recommend lifestyle changes such as eating smaller meals, avoiding alcohol, and not eating right before bed. Surgical repair may be needed in some cases.

  • Esophageal cancer-- this is a rare condition, but its presence is increasing in the United States.

Although having this condition is highly unlikely, if you have longstanding heartburn, and especially if you have risk factors for this condition such as smoking or drinking heavily, your family doctor may decide to order an upper endoscopy to examine your esophagus. 

  • Diabetes-- Poor control of diabetes can lead to nerve damage, which can affect the nerves of your digestive tract. This is called gastroparesis, and it dramatically slows the movement of food through the stomach which can cause heartburn.

For gastroparesis, treatment can include lifestyle changes like eating smaller meals, avoiding fat and fiber and taking medications. The key here is to get your blood sugar under control and your family doctor can help you with this goal.

  • Esophagitis-- Frequent acid reflux can cause inflammation of the esophagus. This condition can lead to more heartburn, as well as difficulty swallowing.

The esophagus can also become inflamed from taking certain medications, particularly if the pills are taken without water, allowing them to remain in the esophagus. Be sure to take medications with plenty of water. A third type of esophagitis, called eosinophilic esophagitis, occurs when white blood cells invade the esophagus. Your family doctor can assist in treatment for this. 

  • Pleurisy-- also known as pleuitis, this condition is an inflammation of the lining of the lungs and chest cavity and can cause heartburn-like chest pain. Pleuritis should be suspected if the pain or burning gets worse when you take deep breaths or are up moving around.

Pleuritis is usually caused by a viral or bacterial infection, and resolves when the infection does.

  • Costochondritis-- inflammation of the cartilage anchoring ribs to the breastbone causes sharp pain along the breastbone or sternum. It can be due to injury or infection, and typically is treated with anti-inflammatory medicines, pain relievers, and rest.


  • Anxiety-- I can't emphasize this condition enough. Although anxiety does not cause GERD, it can cause severe heartburn and make GERD symptoms worse. A person can have both anxiety-related heartburn and GERD-related heartburn. Stress and anxiety exacerbates this condition. One sign it's not just reflux is that treating the reflux problem doesn't make it any better.

Reducing stress and anxiety can ease heartburn. Try exercise, meditation, therapy, yoga, tai chi, or deep breathing.

Your family doctor can help you get to the root of the problem. Especially if acid-reducing medications have not helped, or if your heartburn-type pain is recurring, it is important to sit down and have a good discussion with your family physician about your specific symptoms and how to get to feeling better. 


Dr. Paul Leavitt is a Board Certified Family Doctor and practices at Leavitt Family Medicine in Hendersonville, TN. At Leavitt Family Medicine, we are here for you, for all of your medical and health care needs. We welcome your questions and comments and invite you to visit us at Let us know how we can help you today!


Posted on 10/22/2011 9:39 AM by Paul J. Leavitt, M.D.
Thursday, 20 October 2011
Ask Dr. Leavitt: I have High Blood Pressure. How can I lower it?

Researchers have found people with even slightly elevated blood pressure, called prehypertension, are at a 50% higher risk of stroke than people who have normal blood pressure, known as normotension. This is just one of the many reasons getting to goal, reaching your blood pressure goal, is so important.

Hypertension, or high blood pressure, is life-threatening because it can lead to stroke, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to decrease high blood pressure and protect your body, including blood vessels and organs. Reaching normal blood pressure level has been associated with risk reduction in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%), according to research.

What are the defined levels of high blood pressure?

  • Normal blood pressure: less than 120/80 mmHg
  • Prehypertension: 120-139/80-89 mmHg
  • Hypertension: greater than 140/90 mmHg
  • Stage 1 Hypertension:140-159/90-99 mmHg
  • Stage 2 Hypertension: 160 or greater/ 100 or greater mmHg

All patients with blood pressure two or more consecutive readings greater than 120/80 should talk with their family doctor about developing a plan to get them to their blood pressure goal.

Your family doctor can help teach you what lifestyle modifications to make, including eating a healthier diet, quitting smoking, and getting more exercise. Temporary treatment with blood pressure medication is recommended to lower blood pressure to less than 140/90 mmHg. This blood pressure medicine can be used until blood pressure is lowered from lifestyle modifications. For patients who also have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80 mmHg.

How to Reach your Blood Pressure Goal

An essential step in preventing and treating high blood pressure is making healthy lifestyle choices. You can lower your blood pressure by implementing these lifestyle changes:

  • Lose weight if you are overweight or obese.
  • Quit smoking.
  • Eat a healthy diet (think lean protein, fresh fruits and vegetables, low fat dairy products, less trans and saturated fat.
  • Reduce the amount of sodium in your diet to less than 1,500 milligrams a day.
  • Get regular aerobic exercise (walk at least 30 minutes a day, several days a week).
  • Limit alcohol to two drinks a day for men, one drink a day for women.

These steps not only lower blood pressure, they enhance the effectiveness of high blood pressure medicine.

High Blood Pressure Follow-Up
After starting high blood pressure medication therapy, you should see your family doctor at least once a month until your blood pressure goal is reached. Once or twice a year, your family doctor will check the level of potassium in your blood and other electrolytes and BUN/creatinine levels (to check your kidney health).

After you reach your blood pressure goal, you should continue to see your family doctor every three to six months, especially if you have other conditions such as heart failure.

 Dr. Paul Leavitt is a Board Certified Family Doctor in Hendersonville, TN. He sees patients of all ages and has a special interest in high blood pressure, high cholesterol, and diabetes. At Leavitt Family Medicine, we are here for you, for all of your medical needs. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 10/20/2011 9:43 PM by Paul J. Leavitt, M.D.
Wednesday, 19 October 2011
Ask Dr. Leavitt--I was recently diagnosed with hypothyroidism. What can I do to feel better?

Hypothyroidism is a condition that happens when the thyroid does not make enough hormone. The thyroid gland is in the front of the neck just below the voice box. It releases hormones that regulate metabolism.

The most prevalent cause of hypothyroidism is inflammation of the thyroid gland, which damages glands cells. Hashimoto's thyroiditis, when the immune system attacks the thyroid gland, is the most common example of this inflammation. Some women can develop hypothyroidism after pregnancy (known as postpartum thyroiditis).

Common causes of hypothyroidism include:

  • Congenital (birth) defects
  • Radiation treatments to the neck to treat different cancers, which may also damage the thyroid gland
  • Radioactive iodine used to treat an overactive thyroid (hyperthyroidism)
  • Surgical removal of part or all of the thyroid gland, done to treat other thyroid problems
  • Viral thyroiditis, which may cause hyperthyroidism and is often followed by temporary or permanent hypothyroidism

Early symptoms include:

  • Being more sensitive to cold
  • Constipation
  • Depression
  • Fatigue or feeling slowed down
  • Heavier menstrual periods
  • Joint or muscle pain
  • Paleness or dry skin
  • Thin, brittle hair or fingernails
  • Weakness
  • Weight gain (unintentional)

Later symptoms include if left untreated:

  • Decreased taste and smell
  • Hoarseness
  • Puffy face, hands, and feet
  • Slow speech
  • Thickening of the skin
  • Thinning of eyebrows

A physical examination may reveal a smaller than normal thyroid gland, although sometimes the gland is normal size or even enlarged (goiter). The examination may also reveal:

  • Brittle nails
  • Coarse facial features
  • Pale or dry skin, which may be cool to the touch
  • Swelling of the arms and legs
  • Thin and brittle hair

Your family doctor can order specific lab tests to check for thyroid disorder.

Lab tests to determine thyroid function include:

  • TSH test
  • T4 test

Lab tests may also reveal:

  • Anemia on a complete blood count (CBC)
  • Increased cholesterol levels
  • Increased liver enzymes
  • Increased prolactin
  • Low sodium

The goal of treatment is to replace the thyroid hormone that is lacking. Levothyroxine is the most commonly used medication. Doctors will prescribe the lowest dose possible that effectively relieves symptoms and brings your TSH level to a normal range. If you have heart disease or you are older, your family doctor may start with a very small dose.

Lifelong therapy is required unless you have a condition called transient viral thyroiditis.

You must continue taking your medication even when your symptoms go away. When starting your medication, your doctor may check your hormone levels every 2 - 3 months. After that, your thyroid hormone levels should be monitored at least every year.

Very Important things to remember when you are taking thyroid hormone are:

Do NOT stop taking the medication when you feel better. Continue taking the medication exactly as directed by your family doctor.
If you change brands of thyroid medicine, let your doctor know. Your levels may need to be checked.
Thyroid medicine works best on an empty stomach and when taken 1 hour before any other medications.
Do NOT take thyroid hormone with fiber supplements, calcium, iron, multivitamins, aluminum hydroxide antacids, colestipol, or medicines that bind bile acids.

In most cases, thyroid levels return to normal with proper treatment. However, thyroid hormone replacement must be taken for the rest of your life.

If you are being treated for hypothyroidism, call your family doctor if you:

  • develop chest pain or rapid heartbeat
  • have an infection
  • symptoms get worse or do not improve with treatment
  • develop new symptoms

Be sure to sit down and have an in-depth discussion with your family doctor about your specific symptoms.

At Leavitt Family Medicine, we are there for you, for all of your medical needs. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 10/19/2011 10:22 PM by Paul J. Leavitt, M.D.
Monday, 17 October 2011
If You Have Diabetes--Get Your Flu Shot

People dealing with diabetes should get a flu vaccine every year. You should get the flu shot fairly early in the Fall because it takes about two weeks to start working. Flu season can last until early Spring, so there are benefits of getting your flu shot until February.  And if you haven’t already done so, a pneumonia shot is also recommended. This can be done any time during the year. One pneumonia shot is generally needed in a lifetime. Some conditions may require an additional pneumonia vaccine.

Why It's Important

Diabetes can weaken the immune system causing people with diabetes to be more likely to catch the flu and also to catch more severe cases of it. People with diabetes are six times more likely to be hospitalized with flu complications. People who have diabetes and get the flu or pneumonia are about three times more likely to die from it. 

More Ways to Protect Yourself this Flu Season

  • Encourage close family and friends to get their flu shot. Flu is highly contagious so keeping others well around you will lower your risk of getting the flu. 
  • Stay away from people who are sick with the flu since it is so contagious.   
  • Regularly wash your hands or use hand sanitizer. This is extremely important. Lysol has also been proven to kill the flu bug. While much of the flu is spread through the air, some is spread through touch. Think of all the things you touch daily that others do as well-phone, doorknobs, remote controls, keyboards, and money. Keep your hands clean especially before eating or touching your face and mouth. Another good habit is to wash your hands thoroughly the first thing when you get home.
  • Be sure to eat well--a healthy diet with good variety to boost your immune system. A diet that is rich in lean protein, fruits, vegetables, and whole grains is a good start. Talk to your family doctor to make sure you are doing all you can to boost your immune system, including getting good levels of vitamins and minerals.

*** Very Important Tip: Always talk with your family doctor before getting any vaccine. The flu vaccine should be avoided if you have an allergy to eggs, chicken, or if you have had a breakthrough flu, meaning you caught the flu two weeks or after getting your flu shot.

Most health insurance policies, including Medicare and Healthspring, cover costs for both the flu shot and pneumonia shot so there is no excuse not to get your vaccinations if you want them.

Dr. Paul Leavitt is a Board Certified Family Physician in Hendersonville, TN who practices at Leavitt Family Medicine. He is Accepting New Patients and Most Insurances including Healthspring and Medicare. We welcome your comments and questions. Let us know how we can help you today!

Posted on 10/17/2011 9:37 AM by Paul J. Leavitt, M.D.
Tuesday, 11 October 2011
Ask Dr. Leavitt--I have gout. What foods should I avoid?

Gout is an extremely painful form of arthritis. This condition is chronic in nature with severe, brutal acute attacks. Gout has long been associated with diet, particularly eating too much meat, seafood (shellfish) and alcohol. Because of this, treatment for gout used to involve severe dietary restrictions, which made the gout diet hard to stick with. Now that newer medications are available to treat gout, the need for a strict gout diet has been reduced, although following the guidelines is highly recommended.

The gout diet resembles the healthy eating plan recommended for most people in many ways. Besides helping maintain a healthy weight and avoiding many chronic diseases, this diet may contribute to better overall management of  your gout.


How does gout occur?

Gout occurs when high levels of uric acid in your blood cause crystals to form and accumulate around a joint. Your body produces uric acid when it breaks down purines. Patients with gout either under excrete or over produce uric acid. Which one you are will determine the type of medicine needed to resolve the attack. Purines occur naturally in your body, but you also get them from eating certain foods, such as organ meats (processed lunch meat such as bologna, hot dogs, ham), anchovies, herring, shellfish such as crab and lobster, asparagus and mushrooms.


How does it help?

A gout diet helps to control the production and elimination of uric acid, which may help prevent gout attacks or reduce their severity. If you look at uric acid crystals under a microscope, they look like tiny round balls with spikes all around them. Many patients say gout flare ups feel like hot needles stabbing them. Most cannot even tolerate the weight or touch of a bedsheet on the affected area. The diet is not a treatment for gout, but may help you control the number and severity of attacks. Obesity also is a risk factor for gout, so losing weight can help you lower your risk of attacks.

How does it work?

The gout diet reduces your intake of foods that are high in purines, which helps reduce your body's production of uric acid. If you are overweight or obese, it is important to lose weight. However, avoid fasting and rapid weight loss because these can bring on a gout attack. Drink plenty of liquids to help flush uric acid from your body. Avoid high-protein diets, which can cause you to produce too much uric acid (hyperuricemia).

To follow the diet:

  • Avoid or severely limit high-purine foods, such as organ meats, herring, anchovies and mackerel. Red meat (beef, pork and lamb) that has been cured or processed, and seafood (shrimp, lobster and scallops) are associated with increased risk of gout. Because all meat, poultry and fish contain purines, limit your intake.
  • Eat more plant-based proteins. Increase protein by including more plant-based sources, such as beans and legumes. Limit or avoid alcohol. Alcohol interferes with the elimination of uric acid from your body. Drinking beer, in particular, has been linked to gout attacks. If you're having an attack, avoid alcohol. When you're not having an attack, drinking one 5-ounce serving a day of wine is not likely to increase your risk.
  • Drink plenty of water. Fluids can help remove uric acid from your body. Aim for 8-16 eight-ounce glasses of water a day.
  • Choose low-fat or fat-free dairy products. Some studies have shown that drinking skim or low-fat milk and eating foods made with them, such as cheese or yogurt, help reduce the risk of gout.
  • Choose complex carbohydrates. Eat more whole grains and fruits and vegetables and fewer simple, refined carbohydrates, such as white bread, cakes and candy.
  • Limit or avoid sugar. Too many sweets can leave you with no room for plant-based proteins and low-fat or fat-free dairy products — the foods you need to avoid gout. Sugary foods also tend to be high in calories, so they make it easier to eat more than you're likely to burn off. Although there's debate about whether sugar has a direct effect on uric acid levels, sweets are definitely linked to overweight and obesity.
  • There's also some evidence that drinking four to six cups of coffee a day lowers gout risk in men.

Following a gout diet can help you limit your body's uric acid production and increase its elimination. It's not likely to lower the uric acid concentration in your blood enough to treat your gout without medication, but it may help decrease the number of attacks and limit their severity. Following the gout diet and limiting your calories — particularly if you also add in moderate daily exercise, such as brisk walking — also can improve your overall health by helping you achieve and maintain a healthy weight.

Be sure to call your family doctor and discuss your gout symptoms. By working with your primary care physician you can create a plan to minimize the frequency and severity of your gout attacks.

At Leavitt Family Medicine, we are here for you, for all of your health care needs. We appreciate your questions and comments; Please let us know how we can help you today!


Posted on 10/11/2011 11:35 AM by Dr. Paul Leavitt
Wednesday, 5 October 2011
Prediabetes: What is it and how can I reverse it?

Being diagnosed with prediabetes is not the end of the world, but it is a wake up call to get in better health. Prediabetes has other names tool-- metabolic syndrome, insulin resistance, syndrome X. If you have any of these terms, it is important to do something about it now.

Before people develop type 2 diabetes, known as diabetes mellitus, they usually have prediabetes or impaired fasting blood glucose. Blood sugar levels > 100 mg/dL (5.5 mmol) but < 126 mg/dL (7 mmol) are considered prediabetes.

Prediabetes means that your blood sugar level is higher than normal, but it's not yet increased enough to be classified as type 2 diabetes. Still, without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less. And, if you have prediabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting.

There's good news, however. Prediabetes can be an opportunity for you to improve your health, because progression from prediabetes to type 2 diabetes isn't inevitable. With healthy lifestyle changes — such as eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight — you may be able to bring your blood sugar level back to normal. 

Prediabetes/diabetes type 2 has become a worldwide epidemic. 57 million people in the United States have prediabetes and most don't even know it, according to the American Diabetes Association.

Mistakenly, many people who believe they're "borderline diabetic" or have "a touch of diabetes" think that they're safe. But research has shown some long-term damage is being done to the body, especially the heart and circulatory system.

Risk factors for prediabetes and diabetes:

  • Being overweight or obese. This keeps your body from making and using insulin correctly. Being overweight can also cause high blood pressure.
  • Having a parent, brother or sister with diabetes. Having a relative with type 2 diabetes, more than doubles your risk of getting the disease.
  • Being of African-American, American Indian, Asian-American, Pacific Islander or Hispanic/Latino heritage.
  • Having gestational diabetes or giving birth to at least one baby who weighed more than 9 pounds (4.1 kilograms).
  • High blood pressure.
  • HDL or "good" cholesterol is < 35 mg/dL (0.9 mmol/L) or your triglyceride level is > 250 mg/dL (2.83 mmol/L).
  • Exercising fewer than three times a week.


You can have prediabetes and not know it. Two tests are commonly used to diagnose prediabetes:

  • Fasting blood glucose. Measures blood glucose first thing in the morning before you eat. A normal fasting blood glucose is between 70 to100 mg/dL (3.8 to 5.5 mmol). You have prediabetes if your fasting blood sugar is 101 to 125 mg/dL (5.6 to 6.9 mmol).
  • Oral glucose tolerance test. Measures blood glucose after fasting and again 2 hours after drinking a glucose-rich drink. Normal blood glucose is below 140 mg/dL (7.7 mmol) 2 hours after the drink. In prediabetes, the 2-hour blood glucose is 140 to 199 mg/dL (7.8 to 11.0 mmol/L). If the 2-hour blood glucose rises to 200 mg/dL (11.1 mmol) or above, you have diabetes.If you have prediabetes, you should do something about it. Studies have shown that people with prediabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle, including modest weight loss (as little as 5 to 7 percent of your current weight) and increasing physical exercise. This makes a major difference!


Prediabetes often has no signs or symptoms.

Darkened areas of skin, a condition called acanthosis nigricans, is one of the few signs of prediabetes. Common areas that may be affected include the neck, armpits, elbows, knees and knuckles.

Classic red flags of type 2 diabetes to look for include:

  • Increased thirst
  • Frequent urination
  • Fatigue
  • Blurred vision

Consult your family doctor if you're concerned about diabetes or if you notice any type 2 diabetes signs or symptoms.

The exact cause of prediabetes is unknown, although researchers have discovered some genes that are related to insulin resistance. Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of prediabetes.

What is known is that people who have prediabetes aren't quite processing sugar (glucose) properly anymore. This causes sugar to build up in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues.

Most of the glucose in your body comes from the foods you eat, specifically foods that contain carbohydrates. Any food that contains carbohydrates can affect your blood sugar levels, not just sweet foods.

During digestion, sugar enters your bloodstream and with the help of insulin is then absorbed into the body's cells to give them energy.

Insulin is a hormone that comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key that unlocks microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

When you have prediabetes, this process begins to work improperly. Instead of fueling your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin or both.

The same factors that increase the risk of developing type 2 diabetes increase the risk of developing prediabetes, including:

  • Weight. Being overweight is a primary risk factor for prediabetes. The more fatty tissue you have — especially around your abdomen — the more resistant your cells become to insulin.
  • Inactivity. The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.Age. The risk of prediabetes increases as you get older, especially after age 45. This may be because people tend to exercise less, lose muscle mass and gain weight as they age. However, older people aren't the only ones at risk of prediabetes and type 2 diabetes. The incidence of these disorders is also rising in younger age groups.
  • Family history. The risk of prediabetes increases if a parent or sibling has type 2 diabetes.
  • Race. Although it's unclear why, people of certain races — including African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders — are more likely to develop prediabetes.
  • Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of later developing diabetes increases. If you gave birth to a baby who weighed more than 9 pounds (4.1 kilograms), you're also at increased risk of diabetes.
  • Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
  • Inadequate sleep. Several recent studies have linked a lack of sleep to an increased risk of insulin resistance. Research suggests that regularly sleeping fewer than 5.5 hours a night might up your risk of prediabetes or type 2 diabetes.

Other conditions associated with diabetes include:

  • High blood pressure
  • Low levels of HDL, or "good," cholesterol
  • High levels of triglycerides — a type of fat in your blood

When these conditions — high blood pressure, high blood sugar, and abnormal blood fats and cholesterol — occur together along with obesity, they are associated with resistance to insulin. This is often referred to as metabolic syndrome.


Here's some information to help you get ready for your appointment, and what to expect from your family doctor.

What you can do


For prediabetes, some question to ask your family doctor are:

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. And, be sure that you understand your doctor's recommendations before you leave.

What to expect from your doctor
Your family doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

Who should be tested
The American Diabetes Association recommends blood glucose screening if you have any risk factors for prediabetes. This includes if:

If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Guidelines from the American College of Endocrinology suggest the following to treat prediabetes:

In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Healthy lifestyle choices remain essential, however.

Because the findings from several recent studies suggest that regularly getting a good night of sleep may reduce insulin resistance, try to get at least six hours or more of sleep each night.

Many alternative therapies — including cassia cinnamon, chromium, ginseng, glucomannan, guar gum, gymnema, magnesium, milk thistle, prickly pear cactus, soy and stevia — have been touted as possible ways to treat or prevent type 2 diabetes. Although some of these substances have shown promise in early trials, there's no definitive evidence that any of these alternative therapies are effective.

If you're considering dietary supplements or other alternative therapies to treat or prevent prediabetes, consult your family doctor. They can help you weigh the pros and cons of specific alternative therapies.

Healthy lifestyle choices can help you prevent prediabetes and its progression to type 2 diabetes — even if diabetes runs in your family.

If the list looks familiar, you're onto something. The same lifestyle changes that can treat or even reverse prediabetes help prevent the condition, too.


    You're likely to start by first seeing your family doctor.
  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. You'll probably need to fast for at least eight hours prior to your appointment so that your doctor can measure your fasting blood sugar level.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.Make a list of all medications, as well as any vitamins or supplements, that you're taking.
  • Write down questions to ask your family doctor.Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together.
  • How can I prevent prediabetes from turning into type 2 diabetes?
  • Is there a medication I can take?
  • What types of side effects can I expect from medication?
  • I have other health conditions. How can I best manage them together?
  • How much exercise do I need?
  • Are there foods I need to avoid? Can I still eat sugar?
  • Do I need to see a dietitian?
  • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
  • Has your weight changed recently?
  • Do you exercise regularly? If so, how long and how often?
  • Do you have a family history of diabetes?
  • You're overweight, with a body mass index above 25
  • You're inactive
  • You're age 45 or older
  • You have a family history of type 2 diabetes
  • You're African-American, Hispanic, American Indian, Asian-American or Pacific Islander
  • You have a history of gestational diabetes or have given birth to a baby who weighed more than 9 pounds (4.1 kilograms)
  • You have a history of polycystic ovary syndrome
  • You have high blood pressure
  • You have abnormal cholesterol levels, including an HDL cholesterol below 35 mg/dL (0.9 mmol/L) or triglyceride level above 250 mg/dL (2.83 mmol/L)
  • Eat healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.
  • Get more physical activity. Aim for 30 to 60 minutes of moderate physical activity at least five days a week. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day
  • Lose excess pounds. If you're overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
  • Take medications as needed. Sometimes medications — such as the oral diabetes drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes. This includes if your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.


At Leavitt Family Medicine, we are here for you, for all your medical needs. We welcome your questions and comments; Please let us know how we can help you.

Posted on 10/05/2011 5:35 PM by Paul J. Leavitt, M.D.
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