I have often read that overweight is a risk factor for Type 2 diabetes. Yet in my own family I have seen that, over the long term, diabetes itself appears to cause weight loss. And despite being reduced to half their size, they are still unable to get rid of the condition. Why is this so? Why does Type 2 diabetes cause people to lose weight? And why doesn’t this help control the condition?
When the cells of the human body get stuffed with fat they stop responding to insulin. This is referred to as insulin resistance. In Type 2 diabetes most patients are overweight and thus insulin resistant. That is why they are only able to gain control of their condition with oral agents (drugs). Now if the person follows a healthy diet and regular exercise plan, he will lose the “fat weight, which makes him insulin sensitive again. But if the diabetes is uncontrolled and blood sugar is high, then the body bums muscle to obtain energy, because insulin is unavailable to break down carbohydrates into glucose. This leads to muscle loss, which makes the body weak and the diabetes remains high and out of control.
So the key is to lose fat and not muscle weight. Individuals whose diabetes is poorly regulated may have lost a lot of weight but they never get cured. Whereas those that lose fat by virtue of intense exercise and a good diet, will get more insulin sensitive and thus are able to overcome their diabetic condition.

I am 73. I am an exercise freak accustomed to regular early morning walks coupled with mild aerobic exercise. Of late, while walking or standing for a long time I experience numbness in my toes, wobble, and lose my balance. An MRI revealed that there is “circumferential disc bulge and posterior disc protrusion at L-4 to L-5 levels, L5-S1 level with compression on S1 nerve root.” I was put on spinal chord rehab which has given only 50% relief. I am continuing the exercises, but not walking as much as I used to, with the result my weight is increasing. At this advanced age with coronary heart disease, is spinal surgery an option, or is it advisable to battle it out as I am doing now? Can I use an exercise bicycle to stay in shape without any damage to the spine?
You have a mechanical problem of spine degeneration with bone formation in the discs and joints. A spine surgery to decompress is acceptable even at your age, as this is a problem of ageing. The surgery will give you considerable pain relief. Still, you will need to exercise prudence to prevent the other discs from deteriorating. The exercycle is unfortunately unkind to the knees. For the present you’ll have to rely on a judicious diet to keep your weight down.
Do keep in mind that when you decide on the surgery, it should be undertaken by a Spine/Neurosurgeon and not a general/ orthopedic surgeon.

My daughters are in their early teens and obsessed with their skin. What can I advise them about eating right and taking care of their skin?
Skin care is extremely important for teenagers. Junk food, carbonated drinks, irregular sleep patterns, stress due to studies, exposure to sun and pollution take a toll on the skin making it dull and lifeless. Acne, dandruff, hair loss, premature graying and even early wrinkles could occur due to improper care. One must have plenty of brightly colored fruits and vegetables such as carrots, tomatoes, oranges, cherries, plums, berries, red grapes, spinach and broccoli. These have a high content of anti-oxidants in them especially vitamin C, E, beta carotene and selenium. Anti-oxidants are free radical scavengers and they protect the skin from oxidative damage, thus helping your skin to remain youthful and glowing. One must also drink 8-10 glasses of water to remain well hydrated. As far as skin care is concerned, don’t try different soaps and shampoos all the time. Use a mild face wash. Avoid going outdoors without applying a sunscreen with an SPF of 30. It is even better if you carry an umbrella. Do not coat your skin with too much make-up. This could block your pores and increase whiteheads and blackheads. If you have dry skin, don’t forget to apply a moisturizer on a slightly moist skin. You could use a scrub once in a week. You could even go to a dermatologist for skin polishing or a skin clean-up once a month.

I have oily skin but in winter my skin gets dry by the time it is evening. Trying to ease the situation, I apply a moisturizer but I get acne as a result. What should I do?
Usage of heavy oil-based or heavy moisturizers is probably blocking your pores leading to more acne. You should use a mild face wash with salicylic acid (saslic foam wash or Salvosh). Salicylic acid works by softening keratin, a protein that forms part of the skin structure. This helps to loosen dry scaly skin making it easier to remove. It also prevents clogging of pores and helps in breakdown of blackheads and whiteheads. Do not use a toner in winter as it would further dry your skin. Apply a gel-based sunscreen. At bedtime, use a mild cleansing lotion such as Cetaphil cleansing lotion instead of soap or a face wash. Soaps alter the Ph balance of the skin making the skin drier. Apply a thin coat of oil-free moisturizing lotion or Emolene cream but do not massage. The massage itself would stimulate sebaceous glands to secrete more sebum or oil. If you still get acne, please consult a dermatologist.