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Wednesday, August 20, 2014
Emphysema and Diabetes
My father is a 72-year old male, reformed smoker (he quit 6 years ago) who has moderate emphysema which is treated by maintenance inhalers. Unexpectedly, he lost almost 40 pounds over the last 6 months. This significant weight loss along with other symptoms including tiredness, dry mouth, frequent urination, blurred vision and numbness in his feet caused him to move up his yearly physical. As a result of this physical and some blood tests he was diagnosed with Type 2 diabetes. I would like to know how this diagnosis will impact his lifestyle, affect his emphysema and what other health risks does this pose such as panceratic cancer? Thank you.
My first question would be assessing whether the diabetes is indeed the reason for the weight loss. Diabetes could be present and may or may not be the cause - the answer to that will come in whether his weight stabilizes when the diabetes is treated and whether his providers see the need to rule out other possible explanations. It also makes a difference whether he was overweight to begin with or whether he was of moderate weight and has gone below the appropriate weight for his height, frame and age. Pancreatic cancer is one of the possible explanations for otherwise unexplained weight loss. For most people with diabetes, the diabetes itself is not a large risk factor for pancreatic cancer.
I congratulate him on stopping smoking and staying off cigarettes - that can have a huge payoff in quality of life and survival. The implications for lifestyle depend to some extent on what form of diabetes he is diagnosed with. If the diabetes was indeed the reason for the weight loss, that would suggest he may have marked reduction in the ability to produce his own insulin. That in turn will be a major factor in whether he needs to be treated with insulin.
Much of taking care of diabetes is learning how to manage the right balance between healthy eating and physical activity and medication. Having a positive attitude towards making changes if they are necessary will make a huge difference in the impact those will have on his life. I would encourage getting a good start from seeing a certified diabetes educator to learn how to take control of his diabetes rather than letting his diabetes control him.
The better a job he does of controlling his diabetes, the less interaction and interference there will be between the diabetes and the emphysema.
He has learned about getting dehydrated and that would be a problem for clearing airway secretions if he doesn't maintain adequate fluid balance. One concern will be that if/when he needs oral steroids for his breathing problems, that will have an impact on the blood sugar control and the two can then cause a bit of an upward spiral. Important to learn ahead of time what to do for controlling the blood sugars when steroids cannot be avoided.
I have attached web links to several public information sites that should help you further
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati