Dear Dr. Roach: In a recent column, you noted that “atorvastatin can increase blood sugar.” Is this true of all statins? If not, are there statins that are better or safer for someone with diabetes in the family?
M.C.W.
Yes, it is true that all statins may increase blood sugar. Higher dosage and higher potency of the statin may have more of an effect. On average, statins raise the A1C level by about 0.3%, which is not that much. A 2016 analysis estimated that high-dose statin therapy, such as 40 mg of atorvastatin daily, would lead to somewhere between 50 to 100 new cases of diabetes in 10,000 treated individuals.
It’s very important to remember that people with diabetes are at such a high risk for heart disease that the benefit from statins greatly outweighs the risk, which has been shown in multiple large clinical trials.
Dear Dr. Roach: A physician recently diagnosed me with an inguinal hernia. I’ve had it for about eight months on my left side. I do wear a support belt most of the time. I’m a 71-year-old man in good health, and I recently retired. The hernia doesn’t cause any pain or discomfort and doesn’t present any physical limitations.
My question is, should I treat it via surgery? If so, what method? I read so much about lawsuits over botched hernia procedures (especially those using mesh).
P.M.
A hernia is a defect in the abdominal wall, through which abdominal contents can bulge. The goal of hernia surgery is to relieve symptoms and prevent the abdominal contents from getting trapped outside the abdominal cavity (an emergency case known as incarceration). There are many locations for hernias, including the umbilicus (belly button) and prior scars, but the most likely location is still inguinal — in the groin.
Since you have no symptoms, the only reason to operate would be to prevent problems. A 20-year-old has a lot more time for the hernia to stretch out than you do, so surgeons are a bit more circumspect about operating on older people.
Although, if you needed it, the surgeon would certainly operate. However, the likelihood of an emergency developing is small (less than a 5% risk over the next 20 years), and it’s entirely reasonable to watch if any symptoms develop and wait to do the surgery until then.
If you do require surgery, you should get advice from your surgeon. I never second-guess the surgeon’s choice of technique, as that is the surgeon’s expertise. For a typical patient, most surgeons choose tension-free mesh repair done via a laparoscope.
Dr. Roach Writes: A recent column on alcohol abuse generated many letters, most of which pointed out that I had a typographical error. Alcohol use of greater than 14 drinks per week puts people at a greater overall risk for health problems, while the column stated that more than 14 drinks per day was the amount. I sincerely hope nobody really believed that 14 drinks per day was safe.
Several other people were upset that I said the word “alcoholic” is imprecise and doesn’t get used in a medical context. I understand that this is a term many people use to describe themselves, and that it is commonly used in the context of problem drinking. However, the terminology that is instead used in a medical context is more precise and differentiates between unhealthy alcohol use, risky alcohol use and alcohol use disorder.
Many people choose to describe themselves in ways that have negative connotations, have had so in the past or are considered stigmatizing. However, you don’t need to say you are an “alcoholic” to admit you have a problem with alcohol and need help.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
