Can you point me to any data on whether people with diabetes are prone to canker sores or other mouth sores?

Bill Sklar
Tucson, Arizona

There is no specific diabetic feature related to the mouth, but a number of non-specific abnormalities have been recorded in the medical literature. These include gingivitis and tenderness about the teeth, dryness of the mouth and heavy tartar deposits. A fruity breath can be noted if the glucose balance is out of control. Oral and skin manifestations can be many and varied, ranging from trivial to life-threatening; however, none are specific. What is the incidence of oral involvement in diabetes? Because there are no specific findings and to date every reported finding associated with diabetes also is found to some extent in non-diabetic individuals, the incidence of oral involvement really depends on how one defines involvement.

Canker sores, also known as aphthous stomatitis, is a common erosive or ulcerated disorder of the oral cavity. The incidence probably approaches 20 percent in the general population and is not indicative or specific in people with diabetes. Stomatitis is a general term for oral mucosal inflammation and can result from multiple causes, such as drug reactions, irritation or allergic reactions. Recurrent canker sores are painful and commonly last seven to 10 days, but deep lesions may take 10 to 30 days to heal and cause significant oral pain and oral discomfort.

The cause of this disorder is obscure and multifactorial. Many predisposing factors have been suggested and include infectious agents, trauma, stress, hormonal changes, nutritional deficiencies and systemic disorders. "Tincture of time" is the best treatment since most treatments are relatively unsatisfactory and must be individualized. Topical anesthetics provide temporary relief and oral rinses may be helpful. Topical cortisone derivatives can be applied frequently to abort early lesions and should be discontinued if the ulcers are deep or infected. Many systemic agents have been tried, but some have serious side effects. Systemic corticosteroids can be used for short courses in severe disabling episodes, but these can also have serious side effects and do not affect the natural history of the disorder.

S. William Levy, MD
Clinical Professor of Dermatology
University of California
San Francisco Medical Center

After becoming a type 1 and taking insulin, I gained about 35 pounds. It occurred to me that doctors always blame type 2 diabetes on people being overweight, but isn't it possible the opposite is true? Could insulin resistance and the subsequent hyperinsulinemia that results cause weight gain?

Dara May
New York, New York

You are exactly correct and if this was a quiz show you would have just answered the million dollar question. The focus on insulin resistance and resulting hyperinsulinism in a "glucocentric" manner is totally incorrect and leads to a delay in diagnosis and treatment or intervention to minimize damage of a disease that is more a disorder of the cardio-metabolic health of human beings than just a disease of elevated glucose.

Ralph DeFronzo did a study many years ago showing that all patients studied with coronary artery disease had insulin resistance and Geral Reaven showed the same resistance to the effect of insulin is found in people with increased weight or obesity even when their blood sugars are normal.

Alan Marcus, MD, FACP
South Orange Endocrinology
South Orange, California

I hear that "unfiltered" coffee is bad for people with diabetes. Is this true? Also, is instant decaffeinated coffee classed as "filtered" coffee?

Antony Johnson
Internet

There is no significant difference between percolated (brewed, unfiltered) coffee and drip coffee. The caffeine content of each type of coffee is very similar, about 150 mg per 8 ounce cup.

Coffee is linked to some negative health effects, independent of caffeine content, including raising cholesterol and blood pressure levels. As with all things, moderation is recommended because in excess, caffeine could potentially raise blood sugar levels.

Because caffeine has many negative side effects including being addictive, I generally recommend trying to reduce coffee consumption for persons who drink more than two cups per day.

The negative side effects of caffeine include:

• it reduces the absorption of iron and calcium
• it is a diuretic
• it is linked to stomach upset
• excess caffeine consumption is linked with trouble sleeping.

To reduce caffeine in coffee try the following:

1. use half-decaf and half-regular coffee, then switch to decaf
2. limit yourself to one to two cups of coffee per day
3. try hot tea.

Dana Arnold, MS, RD, CDE
Clinical Dietitian
Daly City, California

I am from India presently working in Northern Iraq on an assignment. While in India, I used to walk every morning for 30 to 40 minutes. But in Northern Iraq, due to extreme cold conditions, morning walks are not possible.

Can you suggest any indoor exercises?

Guru Ammanagi
Iraq

When it is not possible to walk outdoors, you can still get an aerobic workout inside.

The easiest way to get a workout similar to walking is to do bench stepping. Bench stepping is actually used as a means to test aerobic capacity similar to treadmill walking. Others engage in aerobic "step" classes in fitness centers. All you need for this activity is a step or something on which to step up. It would be best to start with a small step and then gradually increase the height of the step you are using (either during the activity or the next time you do it). A step as little as 4 cm high would work to start. To begin exercise, simply place one foot, then the other, on the step; step off in the same order and repeat this movement for the length of time you desire. Don't give up if you tire easily at first. Try switching the lead foot from right to left and back again as needed to relieve fatigue in one leg. You can also take short breaks (two to three minutes) between stepping sessions of five to10 minutes. Try listening to music to pass the time.

If stair-stepping is not your cup of tea, however, you can also try jumping rope, running in place (interspersed with rest intervals) or calisthenics (jumping jacks, push-ups, crunches, leg lifts).

Sheri Colberg, PhD
Assistant Professor of Exercise Science
Old Dominion University
Norfolk, Virgina