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The Hormone Whisperer

Endocrinologist Elena Christofides MD answers all of the questions you were afraid to ask at your last checkup


Q: “I’m overweight and beginning to suspect I may have prediabetes or type 2 because of some early warning signs like always being thirsty and having to pee a lot. I know I should make an appointment to get tested, but I’m too afraid that my doctor will shame me for my weight and scold me about my diet. I already know I need to change these things, and don’t want to have to hear it again from my PCP. Is there a way I can find a doctor who won’t do this? I’ve had bad experiences with MDs shaming me about my weight before. I don’t want to have to subject myself to it again, but I also know I have to do something if I'm developing pre- or type 2 diabetes.”

-James, Kansas City

A: First, let me apologize on behalf of my profession for the way you have been treated in the past. It is not acceptable to shame patients for medical conditions that they neither caused nor asked for. In that regard, please know that obesity is a disease in and of itself. Sure, there are elements of your lifestyle that can contribute, but the genetic components are just as significant as those that determine your hair or eye color.

My concern for you at this moment is that you seem to be experiencing symptoms that may be suggestive of actual diabetes, rather than prediabetes. The feeling of excessive thirst or the need to urinate frequently can be signs or symptoms of high blood sugar. Other signs of high blood sugar can be blurry vision, frequent yeast infections or excessive sleepiness. Prediabetes often has no signs or symptoms, so I would encourage you to visit a doctor sooner rather than later. Prolonged, untreated high blood sugar can lead to heart attack, stroke, kidney failure, pancreatitis or ketoacidosis.

Prediabetes can be effectively managed with lifestyle changes, but diabetes often requires medication for long term protection. It is not enough to just diet and exercise once diabetes has been diagnosed, you will need to find a doctor you can trust who will listen to you and work with you to get your health back on track.

Contrary to popular misconception, the risks to you are greater from the underlying hormonal and metabolic alterations that can dramatically increase your risk of heart disease as opposed to the effects of high blood sugar alone. It can take many years for high blood sugar to damage your organs, like your eyes (retinopathy), kidneys (nephropathy) or nerves (neuropathy). But damage to your cardiovascular system begins in the prediabetes phase and accelerates once diabetes has developed. High blood sugar is not actually the biggest threat to a person with unmanaged diabetes. That is vascular disease that can ravage the circulatory system leading to heart attacks or strokes if left untended.

Luckily, there are effective medications that are proven to reduce your risk of having a cardiovascular event. Many have the additional benefit of weight loss as the main side effect. A combination of medication with lifestyle changes and the guidance of a compassionate endocrinologist are a very effective arsenal to help you reach your long-term health goals.

You have multiple options for finding a physician who will be more collaborative in your journey to long-term health. I recommend visiting the website of the American Association of Clinical Endocrinologists (AACE) and searching for an endocrinologist that also lists obesity as one of their areas of expertise, not just diabetes. This will ensure that you are accessing the most qualified physicians who have an interest in a more holistic approach to your medical management. The website www.dietdoctor.com also lists physicians who focus on incorporating healthy lifestyle choices for managing obesity in conjunction with diabetes. 

To help you prepare for your appointment, I suggest viewing the patient resources on www.obesity.org and www.shopwiththedoc.com in addition to the websites listed above for information on the best lifestyle options to get you on the path to managing both your weight and blood sugar. Remember, the first step of asking for help is usually the hardest. Everything after may very likely feel like a relief.


Elena Christofides, MD

Dr Christofides practices endocrinology in Columbus, Ohio at Endocrinology Associates, a division of The MediZen Institute. Dual board certified in Endocrinology, Diabetes, Metabolism and Internal Medicine, she also runs an independent research facility, Endocrinology Research Associates. She is currently the Vice-Chair of the Nutrition and Obesity Resource Center at the American Association of Clinical Endocrinologists. Her patient education video series on nutrition, Shop With The Doc, won a Silver Medal, the highest honor for a non-commercial entity, in the prestigious Telly Awards for 2019. You can find her on Twitter @DrElena.

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