DEAR DR. ROACH: I am a 90-year-old male on glipizide for Type 2 diabetes and finasteride for an enlarged prostate. I take daily walks and follow a careful but not strict diet.
Lately, the frequency of my urination has increased to every two hours throughout the day and night. Is a change in medication indicated? — C.H.
ANSWER: A thorough evaluation is indicated. There are three possibilities that I see immediately, but several others are also worth considering. Any person with diabetes who notes increased urination should be evaluated for high blood sugar.
Glipizide alone might be a good treatment for you, but we hardly ever start our patients on it anymore because other medicines have proven to be better. Glipizide works by forcing the pancreas to make more insulin, but since the problem with Type 2 diabetes is insulin resistance, more insulin isn’t ideal.
Many people treated with glipizide for years eventually fail, and blood sugar also goes up. Very high blood sugar overwhelms the kidney’s ability to reabsorb sugar, so sugar and water are lost in great amounts by the kidney. A urine and blood sugar test can evaluate this possibility, and an A1C test can show how your blood sugar control has been. If you are urinating a lot every two hours, that would support this possibility. Most people also have other symptoms, like blurry vision or feeling thirsty all the time.
You are also taking medicine for an enlarged prostate, but despite treatment, you still may have a prostate so enlarged that you don’t feel fully empty. If you are only urinating a small amount every two hours and feel that you haven’t completely emptied your bladder, that can support this hypothesis. A sonogram after urinating can confirm this guess, but even an exam might indicate a full bladder.
Older men with prostate problems may also get urine infections. Abnormal urine color or odor supports this, and it is confirmed by urinalysis and a culture test. There are many other less-likely possibilities, but these are the first theories that come to my mind as a primary care doctor.
DEAR DR. ROACH: I am a 62-year-old woman who has never smoked, but my family members have. I was recently diagnosed with a type of lung cancer called lepidic-predominant adenocarcinoma. Is this the same as regular lung cancer? They say they caught it early. How dangerous is it? — V.P.
ANSWER: There are more than 30 distinct types of lung cancer, although adenocarcinoma is the most common, accounting for about half of all lung cancers. However, there are different pathological subtypes of adenocarcinoma of the lung based on the appearance of the tumor. One of these is lepidic-predominant adenocarcinoma, which tends to grow more slowly than other types of adenocarcinoma.
Although smoking is by far the biggest risk factor for lung cancer, approximately 19% of women who get lung cancer were never smokers. Secondhand smoke is a risk for women with prolonged smoke exposure as an adult.
As a general rule, in a person with lung cancer that is confined to one area of the lung without any evidence of spreading, surgery remains the first option for treatment if the person can tolerate it and the tumor is in an amenable place for surgical removal.
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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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