Weight loss, healthy diet are best medicine for diabetics

Q: I have Type 2 diabetes. Is there anything I can do to cut down on my medications?

A: Yes. In fact, some of my patients have entirely eliminated their need for medication with aggressive lifestyle changes. And many more have reduced the number or the dose of the medications they are taking with the same lifestyle changes.

You can reduce or eliminate multiple medications even if you've been taking them for a long time. The secret: You must lose weight and make a lifelong commitment to a healthy diet and regular exercise.

That's not a surprise. An unhealthy diet, lack of regular exercise and weight gain all play a big role in causing Type 2 diabetes in the first place.

People with Type 2 diabetes have elevated levels of blood sugar, or glucose. That's because glucose cannot get from the blood into cells, which need it for energy.

It takes a key to open the door to your cells and let in the sugar that's in the blood. This key is the hormone insulin. In Type 2 diabetes, insulin can't effectively open the cell doors. This is known as insulin resistance.

Your pancreas initially tries to overcome insulin resistance by producing more insulin. This leads to a vicious cycle of continually rising insulin levels, greater insulin resistance and more insulin production.

Eventually, the pancreas cannot keep up with the demand for more insulin. You wind up with a “pooped pancreas.” That's when your blood sugar starts to rise.

Losing weight can reverse the course of Type 2 diabetes. It does so by making your cells more sensitive to insulin. Weight loss can also help prevent long-term diabetes-related health problems. These include heart disease and damage to the nerves, kidneys and eyes.

How does losing weight help make your cells more sensitive to insulin and thereby lower your blood sugar levels?

One theory is that your fat cells make a hormone that then travels in the blood and causes cells to resist the effect of insulin. The fatter your fat cells get, the more of this hormone is produced. One candidate hormone called “resistin” has been discovered, and its role in causing insulin resistance is being studied.

Regular exercise promotes weight loss by burning calories. Even if regular exercise does not cause you to lose weight, it decreases your insulin resistance.

Recently, another hormone called “irisin” was discovered here at Harvard Medical School. When you exercise, your muscles make more of this hormone. As a result, you burn more fat. In their instructive new book, “The Diabetes Breakthrough,” my colleague Dr. Osama Hamdy, medical director at Harvard Medical School-affiliated Joslin Diabetes Center, and Sheri Colberg lay out a specific program of weight loss through diet and exercise to help you reverse Type 2 diabetes and reduce or even discontinue your diabetes medications. You can learn more about this book on my website, AskDoctorK.com.

Q: I just found out I have a Baker's cyst. Is it serious? How is it treated?

A: A Baker's cyst is a fluid-filled sac that can form in the popliteal space, the hollow at the back of the knee joint. A Baker's cyst is filled with synovial fluid, a viscous material that lubricates the knee joint.

I spoke to my colleague Dr. Celeste Robb-Nicholson, associate professor of medicine at Harvard Medical School, about this condition. Baker's cysts tend to occur in adults between the ages of 35 to 70, although they can occur in children and older adults as well.

These cysts often do not cause symptoms. It's not uncommon for an MRI ordered for another type of knee problem to incidentally reveal a Baker's cyst. The cysts are more common in people who have arthritis of the knee or who have had some kind of knee injury.

When the cysts do cause symptoms, they include pain in the back of the knee, stiffness of the knee and a balloon-like swelling in the back of the knee.

Sometimes that swelling hurts when it is squeezed. Usually people have checked their other knee, and noticed a clear difference between the knee that has the cyst and the one that doesn't.

The symptoms typically get worse with any activity that uses the knee, including standing for long periods.

A Baker's cyst may result if an injury to the knee triggers cells lining the knee joint to produce excess synovial fluid. If the fluid bulges into the popliteal space, a cyst can develop. (I've put an illustration of a Baker's cyst on my website, AskDoctorK.com.) Baker's cysts aren't dangerous, and they may go away on their own. But occasionally they burst.

If that happens, synovial fluid can leak into the calf, causing pain and swelling. If a Baker's cyst causes discomfort or interferes with normal activities, there are several things you can do.

To ease swelling, apply a cold pack or compression wrap to the area. To reduce inflammation, take an over-the-counter NSAID drug such as ibuprofen. Reduce stress on the knee by resting your leg and keeping it elevated whenever you can. When you're up and about, use a cane or crutch. These home remedies often help, but if they don't, your doctor may need to drain the cyst. That involves using a needle and syringe to suck out the excess fluid.

At the same time, the doctor can also inject cortisone into the knee joint to quell inflammation. If the cyst recurs and remains troublesome, you may need a magnetic resonance imaging test to identify the underlying cause.

A Baker's cyst will often recur if the injury that caused it isn't addressed. Rarely, the cyst may need to be surgically removed. In the meantime, protect your knee by doing gentle range-of-motion and muscle-strengthening exercises. And avoid high-impact activities.

• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.