Question: I am 57 and have Type 2 diabetes. I am overweight (6-foot-3-inches tall and 268 pounds) and lead a sedentary lifestyle. My cholesterol, HDL, and LDL are good (LDL is 70). I am taking Vytorin for this. My fasting blood sugar varies from 137 to 200. I have started taking Januvia (100 milligrams) for the high blood sugar, but believe I need a supplement to reduce further, and not exacerbate the weight gain. What can you recommend?

Dr. Hibberd's Answer:

Your weight is no doubt a major obstacle to your ideal diabetic management. Get a dietician consultation and arrange for a suitable exercise program under your doctor's supervision.

While other oral medications are available, and yes probably necessary given your high fasting glucose readings, many endocrinologists will provide nighttime insulin dosing to supplement control in patients with difficult to manage Type 2 diabetes. When your diabetes is under better control, your weight management is going to be easier also.

Use your hemoglobin AIC readings to monitor your diabetic management in the long term, and aim for fasting glucose readings under 126 mg/dl. Hyperglycemia seen in poorly controlled diabetes mellitus is directly associated with an increased incidence of diabetic complications, premature disability, and death.

I recommend you go to the American Diabetes Association Web site for assistance with diet and guidelines.