Ask the Local Doctor

This week's question: What’s the difference between Type 1 and Type 2 diabetes and is either one reversible / curable?

In Diabetes Type 1, the body does not produce insulin. This occurs when a person's own body has destroyed the insulin-producing beta cells in the pancreas. This is where a person does not produce insulin which takes glucose into cells for growth and energy. In Type 1 diabetes, your own immune system destroys cells in your pancreas, so little if any insulin is made. This type of diabetes is also known as juvenile diabetes or childhood diabetes. This type of diabetes is not preventable and not related to lifestyle. It makes no difference whether a person is fat, thin, fit or unfit in regards to a person developing Type 1 diabetes. People with Type 1 diabetes need to take insulin daily, either injected or through an insulin pump. However, research is currently being undertaken to find a way to reverse Type 1 diabetes, and a vaccine is currently being developed which may help to reverse this disease. There is no way to reverse Type 1 diabetes at this time.

In Diabetes Type 2, the cells do not respond correctly to the insulin. People with Diabetes Type 2 have one of two problems, and sometimes both. Either not enough insulin is being produced, or the insulin is not working properly, which is known as insulin resistance. The vast majority of patients who develop Type 2, did so because they were overweight and unfit for some time. This type of diabetes tends to appear later on in life and often called adult onset diabetes. However, there have been more and more cases of people in their 20s developing Type 2, but it is still relatively uncommon. Approximately 85 percent of people who have diabetes have this type of diabetes. Lack of physical activity, being overweight, and some genetic factors make it much more likely that the cells build up insulin resistance more quickly. It is important to remember that insulin resistance is not the insulin responding properly, but the cells not responding properly to the insulin. With time and dedication, Type 2 diabetes can be reversed and the results can be very rewarding with less tiredness and better all-round health. Loss of body weight and exercise can be particularly beneficial in helping to reverse the progression of diabetes. In some cases, people may find they are able to come off medication, although blood sugar levels should be checked regularly as reversing progression of diabetes is not a cure.

If you have further concerns you should contact your doctor for more information regarding your condition.

Dr. Magdi Credi

Ask the Local Doctor is sponsored by Insource Urgent Care, 35 Batavia City Centre, Batavia, (585) 250-4201. To submit a question to Ask the Local Doctor, e-mail askthedoc@thebatavian.com. To submit your question anonymously, if you wish, you can use our online form.

Question: Last June I accidentally rolled over my left foot while standing on uneven ground. There was an audible pop from the knee and I felt something let go. To make a long story short, I have seen a local doctor and had X-rays taken. They showed a torn meniscus in the left knee. I was given a shot of cortisone in the knee joint and not much else. I have been taking NSAID on a daily basis and an occasional hydrocodone pill for the pain. The joint gets sore and stiff at night after being on it during the day. Rubbing it down at night and in the morning with Bengay does help. My question is: What is the short-term and long-term diagnoses of this condition in the terms of healing. Can this condition heal itself without surgery? If not, can this condition be corrected through an arthroscopic procedure? I am a 65-year-old male and have been told, my knee joints are pretty much worn out. I don't look forward to spending the rest of my life limping around. It has slowed me down, but has not stopped me from my normal daily activities.

Answer: As with any injury in the body, when the meniscus is damaged, irritation occurs. If the surface that allows the bones to glide over each other in the knee joint is no longer smooth, pain can occur with each flexion or extension. The meniscus can be damaged because of a single event or it can gradually wear out because of age and overuse.

A torn meniscus is damage to the cartilage that sits on top of the tibia and allows the femur to glide when the knee joint moves. Physical examination and magnetic resonance imaging (MRI) is the test of choice to confirm the diagnosis of torn meniscus.

Because there is different blood supply to each part of the meniscus, knowing where the tear is located may help decide how easily an injury might heal (with or without surgery). The better the blood supply, the better the potential for recovery. Blood supply to knee cartilage also decreases with age, and up to 20 percent of normal blood supply is lost by age 40.

The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear, lose its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing.

Some meniscus tears can be treated conservatively without an operation (less than 5 percent) using anti-inflammatory medications and rehabilitation to strengthen muscles around the knee to prevent joint instability. Orthotics may be useful to distribute the forces generated by walking and running.

If conservative therapy fails, surgery may be a consideration. Knee arthroscopy allows the orthopedic surgeon to assess the tear within the meniscus and repair it. Options include sewing the torn edges together or trimming the torn area and smoothing the injury site.

In older patients with degenerative joint disease (alo known as osteoarthritis), where the cartilage wears out, treatment options may be considered over a longer timetable. Exercise and muscle strengthening may be an option to protect the joint and maintain range of motion. As well, anti-inflammatory medications may be considered to decrease swelling and pain arising from the knee joint.

Cortisone medication injections into the knee joint may be used to decrease joint inflammation and to bring temporary symptom relief that can last weeks or months. A variety of hyaluronan preparations are approved for mild to moderate knee arthritis and include hylan G-F 20 (Synvisc) and hyaluronan (Orthovisc).

As a last resort, joint replacement may be an option with substantial degeneration of the knee if conservative measures fail and symptoms of pain and decreasing joint range of motion affect quality of life and prevent the patient from performing routine daily activities.

There is no cookie-cutter approach: The treatment of a meniscus tear depends on its severity, location, and underlying disease within the knee joint, as well as patient circumstances. Consult your doctor to determine what’s the best course of action for you.

Todd Lorenc, M.D.

Ask the Local Doctor is sponsored by Insource Urgent Care, 35 Batavia City Centre, Batavia, (585) 250-4201. To submit a question to Ask the Local Doctor, e-mail askthedoc@thebatavian.com. To submit your question anonymously, if you wish, you can use our online form.

NOTE: This is The Batavian's first "Ask the Local Doctor" column sponsored by Insource Urgent Care. We announced the column and then no questions came in, or so we thought. Their e-mail forwarding wasn't set up right so we didn't see the questions. We actually received about a dozen questions. Those questions have been forwarded to the professional staff of Insource Urgent Care and will be considered for next week's column and subsequent columns.

This column is by Dr. Magdi Credi and it answers the question, should I get a flu shot?

The influenza season is upon us.

Here at Insource Urgent Care the vaccine is being offered for those who are 4 years and older. Unbeknownst to many, influenza is still the most prevalent disease in the United States of all the vaccinated diseases.

About 200,000 persons in the United States will be hospitalized yearly due to influenza. Up to 49,000 deaths occur yearly on American soil due to the flu. Because of this, we here at Insource are doing our best to protect you.

The Center for Disease Control currently recommends all persons older than 6 months be vaccinated. The more persons vaccinated the less chance of the flu.

In particular, two groups are strongly encouraged to obtain the flu shot: those who are at high risk of complications (i.e. pneumonia) and those who care for others at high risk. This would include the following: Parents and caretakers of children less than 6 months of age, pregnant women, persons less than 5 years old or older than 65 years old, and persons with chronic illnesses such as diabetes, asthma, and COPD to name a few. This list is not all inclusive and can be checked out on the CDC’s Web site www.cdc.gov for more information.

If still unsure of your risk or need, please stop by our medical office for clarification. We are here to provide top medical care for you and to protect both you and your family.

This post is sponsored by Insource Urgent Care, 35 Batavia City Centre, Batavia, (585) 250-4201. To submit a question to Ask the Local Doctor, e-mail askthedoc@thebatavian.com.

Next week, look for a new feature on The Batavian: "Ask the Local Doctor."

This will be a new weekly feature on The Batavian sponsored by Insource Urgent Care.

Readers of The Batavian are invited to e-mail medical questions to askthedoc@thebatavian.com and the professional staff at Insource will review the questions and pick one each week to answer in the "Ask the Local Doctor" weekly column.

Insource is tied into a network of local providers as well as partnering with some of the leading clinics and specialists in Western New York such as the Dent Neurologic Institute, Excelsior Orthopedics, UB Neurosurgery and Dr. Ross Sherban, a spine surgeon with Simmons and Sherban Spine and Orthopedics.

The column will give readers access to this broad and deep wealth of local medical knowledge so that a range of medical issues can be addressed.

If a reader's question is selected, the reader will be eligible to receive a free flu shot from Insource.

Of course, questions will be published without the name of the reader who submitted the question.

The e-mail inbox is open. Submit your questions to askthedoc@thebatavian.com