Question: I think your advice is great and I’m wondering if you can help me. I’m taking Aciphex for heartburn and I’m wondering if it can cause elevated blood sugar, as I am a borderline diabetic.

Dr. Hibberd’s answer:

Aciphex is not likely causing your borderline diabetes. But be sure the cause of your heartburn is identified by your doctor as stomach-related (gastro esophageal reflux disease, GERD) and not a sign of heart problems.

It’s also a good idea to use this opportunity to improve your diet and exercise program. Excess weight can contribute to the onset of your glucose intolerance and dropping a few pounds can help you deal with your borderline-diabetic condition. In my experience, most borderline cases are actually not as borderline as patients wish to believe and usually will benefit from early treatment. In any case, you should follow these 10 guidelines:
* Stop smoking.
* Ask your doctor about taking a baby aspirin (81 mg) daily as a preventive supplement.
* Request a referral to a diabetic nurse educator or clinician for an explanation of your condition and review of management strategies recommended for now and later. All diabetic patients should be educated about insulin use early, so that if control becomes problematic you can easily transition to more aggressive management early and prevent the expense of hospital care.
* Request a consultation with a dietician for help with dietary changes that can help you manage your blood sugar.
* Know your correctable risk factors for stroke, cardiac disease, and renal failure (such as high blood pressure, smoking, elevated blood lipids, cholesterol and triglycerides) and manage them aggressively now.
* See an ophthalmologist early and annually to screen and treat you for retinopathy, a very common cause of reversible and preventable vision loss. The findings here are predictive of vascular and kidney damage (called nephropathy) that can lead to kidney failure.
* Know your HBA1C level — a blood measure that indicates the degree to which your diabetes is under control — get into the habit of using a blood-glucose monitor to track your levels.
* Know your blood lipid levels and aim to keep your LDL cholesterol to 80 or less, using a prescription lipid medication (most commonly a statin drug), if necessary.
* Ask your doctor to check your urine for micro-albumin, and consider the daily use of an ace inhibitor as a preventive medication to minimize damage to your kidneys.
* Be sure you have been evaluated for such conditions as hypothyroidism that may be contributing to glucose intolerance.

Most new adult onset diabetic patients will have type 2 diabetes mellitus. There are excellent oral treatments for the condition, such as Metformin, that help normalize insulin sensitivity, and will actually help you return your body to a normal body weight. Weight gain in genetically prone individuals is by far the most common cause of type 2 diabetes.

These guidelines should offer a good place to start. You are not alone, but do be aggressive managing this condition.