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UNDERSTANDING DIABETES IS VITAL TO CONTROLLING IT

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Question: Please discuss type 2 diabetes. My doctor is close-mouthed on info. I read one article on diabetes, and it tells about using vitamin E to improve the condition. Explain, please, differences in the two diabetes types.

- Mrs. M.H.Answer: Don't bank on vitamin E for diabetes control. Send me your reference. Meanwhile, I will endeavor to help you understand the two types of diabetes mellitus.

Your diabetes, type 2, is sometimes called "adult-onset diabetes" or "non-insulin-dependent diabetes."

Type 1 sometimes is referred to as "juvenile diabetes" or "insulin-dependent diabetes."

Both types involve blood-sugar rise; they have different causes.

Type 1 arises from an irreversible defect in the pancreas's insulin-producing cells. Cause of the defect is unclear, but the resulting insulin lack prevents ordinary sugar metabolism, so blood sugar rises. Regular insulin shots permit lifelong sugar control.

Type 2 involves a more subtle failure in insulin control. Here, the body makes insulin, but it doesn't work efficiently. Again, blood sugar rises. Control centers on easing the insulin burden. For example, weight loss helps, since fat cells render insulin less effective. And we have the non-insulin oral drugs to improve the potency of the person's existing insulin.

I don't know why your doctor is silent on the ins and outs of diabetes, since a basic understanding is so vital to control. If you are not getting personal instruction, contact a Diabetes Association chapter, which can supply you with information and local sources of ongoing help.

Question: I have a small granuloma on my lung. About eight years ago I was diagnosed as having histoplasmosis. What is that? Can it come back? How dangerous is it?

- B.S.

Answer: Histoplasmosis is a fungal infection. The fungus lives in soil all over the world, but in the United States its presence is notable in the Mississippi and Ohio river valleys.

Disturbance of soil releases spores into the air, and they can be inhaled into the lungs. Thereafter, in 99 percent of all cases the spores are sealed off harmlessly in granuloma coverings. A granuloma is, in fact, an accumulation of infection-fighting cells that have gobbled up the spores.

You can see evidence of the granuloma on otherwise unremarkable X-rays. It is not something to worry about. The risk of histoplasmosis fungi springing afresh from their granulomatous graves is next to nil.

A few patients might develop a flulike illness early in the infection. Rarely, there can be a need to bring anti-fungal medicine into the picture.

For you, eight years after the histoplasmosis diagnosis, there is no residual threat to health. Forget about it.