Osteoporosis Questions

What is osteoporosis?
Osteoporosis is a condition that weakens bone. The mineral content of the bone becomes depleted, thereby placing the affected bones at increased risk for fracture. Bones especially prone to osteoporotic fracture include those of the hip and spine.

Am I at risk for developing osteoporosis?
There are many risk factors for osteoporosis. Factors such as age, female gender, Caucasian race and family history of osteoporosis cannot be changed. Risk factors that can be changed include stopping tobacco use, taking appropriate amounts of calcium and vitamins, and engaging in weight-bearing physical exercise.

How can I find out if I have osteoporosis or if I am at risk to develop osteoporosis?
A simply x-ray test, called a bone density study, can be performed. This test will provide your doctor with valuable information about your skeletal health. It can be performed in 10-15 minutes. Your health care provider may also want to evaluate blood and urine labs to help better determine your risk for osteoporosis.

I just found out that I have osteoporosis. Is there anything I can do to treat this condition?
Multiple treatment therapies exist. Lifestyle factors such as stopping tobacco use and performing safe weight-bearing exercises can be beneficial. Medications can be prescribed to help to decrease the risk of fracture. Patients may also their optimize calcium and vitamin D intake.

How much calcium and vitamin D should I be taking if I have osteoporosis?
In general, it is recommended that people consume 1200-1500 mg of elemental calcium daily in divided doses with meals. Vitamin D should total 800-1000 units daily in divided doses. These 2 supplements often come together in the same preparation. Your doctor may also wish to perform blood work to more specifically evaluate your vitamin D levels. Dairy products such as milk, cheeses and yogurt are also rich in calcium and vitamin D.

Blood Sugar & Insulin Questions

Is orange juice the best way to treat a low blood sugar?
Orange juice works well, but, like most foods, orange juice takes 15 minutes to raise the blood sugar enough to notice an improvement in symptoms. Milk, juices and most standard meals take the same length of time to work. Even pure glucose can take 15 minutes to produce results when swallowed.

What about adding sugar to orange juice? Does that work faster?
No. This traditional technique still takes about 15 minutes, but tends to result in significantly elevated glucose levels over the next several hours.

Does it make any difference if I take my insulin before or right after my meal?
Yes. The exact timing, however, depends on the type of insulin being used. Short-acting insulins (Novolog, Humalog and Apidra) are usually given right before the meal, while regular insulin is usually given 20-30 minutes before. You should discuss the timing of your insulin with your health care provider.

Cholesterol & Lipids Questions

Are there any symptoms that indicate that my cholesterol is not at goal?
In general, there are no symptoms that would warn you that your lipids are not at goal, and so you will need to check your lipids at least once a year. This can be done through a simple blood test. Talk to your physician about when you will need to have it checked.

Do I need to fast prior to checking my cholesterol?
If you are checking your LDL cholesterol only, there is no need to fast, but, in general, triglycerides are measured at the same time you are checking cholesterol. Triglyceride levels can increase after eating, so it is advised that you fast eight hours prior to testing.

What is the most common misconception regarding cholesterol?
We often hear comments such as, "My cholesterol is less than 200 mg/dl so I am okay." Wrong: When we test for cholesterol, we have the total cholesterol, bad cholesterol (LDL cholesterol) and good or healthy cholesterol (HDL cholesterol). Also, there is another component called triglycerides, which can be high in poorly-controlled diabetes. 

Diabetic patients: regardless of your total cholesterol level, the recommended LDL cholesterol should be less than 100, or, in certain situations, lower.

What are the recommended targets for blood lipids?
The American Diabetes Association (ADA) recommends the following lipid targets:

  • LDL cholesterol below 100 mg/dl
  • HDL cholesterol above 40 mg/dl for men / above 50 mg/dl for women
  • Triglycerides below 150 mg/d

Why do I need to lower my cholesterol?
Studies have shown that lowering LDL cholesterol with the use of statins can reduce heart attack and stroke risks. Additionally, smoking cessation is essential.

How do I reach my lipid targets and lower my LDL cholesterol?
First and foremost, change your lifestyle. This includes dieting and eating less fat, especially saturated fat. Lose weight, or at least curb any weight increase. Increase your physical activity and try to gradually reach a goal of 30 minutes of aerobic exercise--such as brisk walking--most days of the week. Also, there are different types of medications that can be used to lower your LDL cholesterol. The most common first choice is to use a medication from the statin family. These can lower your LDL cholesterol by up to 45 percent. However, they can lead to side effects and you will need to talk to your provider regarding the suitability of using one of the statins. There are other types of medications that can be used to reach your lipid targets, and sometimes medications can be used in combination to reach targets.