The Clinton Herald, Clinton, Iowa

January 8, 2014

Cortisone injections are safe for diabetics

By Dr. Keith Roach
The Clinton Herald

---- — DEAR DR. ROACH: My mom is nearing 90 and recently developed an arthritic hip, which is curtailing her activities. She has Type 2 (no insulin) diabetes. The orthopedic doctor we saw gave her the choices of hip replacement surgery (no!), therapy or a cortisone injection. We almost proceeded with the cortisone injection, until I found out that it can elevate one’s sugar levels. I’m getting conflicting reports of how high the levels can go and for how long. She is not overweight (132 pounds and 5 feet, 1 inch tall) and is allergic to sulfur and penicillin. She also takes medicine for high blood pressure. She is doing her own home therapy (keeping active including stair climbing). — D.C.

ANSWER: Injection of steroids into an arthritic joint is both safe and effective for most people with arthritis. Her surgeon likely will choose a steroid that tends to stay in the joint longer, leading to more improvement and less systemic effects. The effect on blood sugar in people with diabetes usually is minimal and lasts two to three days. Her allergies and other medications should not interfere with the injection.

Although exercise is a great way of treating the arthritis, she should take it easy the day after the injection to allow the medicine to stay in the joint as long as possible. Hip injections usually are done with an X-ray to make sure the injection goes in the right spot.

DEAR DR. ROACH: Both of my parents died with Alzheimer’s disease, and I have great fear of getting it myself. (I’m 70, with worsening memory.) There has been recent news suggesting that copper intake may worsen or even cause the disease. I’ve been looking for foods low in copper, but most of the ones I eat (beans, greens, nuts, whole wheat) are high in copper. — P.M.

ANSWER: Copper has been linked to an Alzheimer’s-type condition in laboratory mice. I recall a similar interest about aluminum and Alzheimer’s disease back in the 1990s, and it turned out not to be a significant issue. Because copper is a necessary nutrient and present in many healthy foods, I would not try to reduce copper intake based on the current information. It is possible (but I think unlikely) that reducing copper intake eventually will be shown to reduce Alzheimer’s, but I wouldn’t change your diet now.

DEAR DR. ROACH: I am a 73-year-old woman, and I have blockages in the arteries of my legs and my carotid artery. I am unable to tolerate any kind of cholesterol medicine, and my doctor told me to try red yeast rice. — C.M.L.

ANSWER: Red yeast rice, a fermented rice product used in Chinese medicine for blood circulation, contains substances that act in a similar way to statin drugs. They generally are well-tolerated, and in one study lowered cholesterol levels by about 20 percent. It isn’t clear whether this reduced risk of heart attack or stroke. Also, these products are not regulated, and have variability in their effects. Finally, no long-term studies have been done to prove safety.

That being said, because of your poor reaction to other kinds of treatments, it may be worth trying if you understand these concerns.