Dear doctor

Diabetes fear

Q If I eat more than a small amount of anything containing a lot of refined sugar, such as sweets, I experience the classic symptoms of hypoglycaemia (as opposed to hyperglycaemia). With all the recent publicity about the dangers of undetected diabetes, I have been wondering whether I ought to be worried. I'm 42, fit and not overweight.

A When we eat a large sugar load the rising blood sugar level releases insulin from the pancreas. The insulin brings blood sugar levels back down to normal, and sometimes even a little below normal. Diabetics don't produce enough insulin and therefore run high sugar levels, which isn't good for blood vessels and organs. As you've experienced, the rapidly falling blood sugar level after insulin release can make some individuals feel rather shaky, sweaty, weak and hungry - all signs that diabetics get when their blood sugar falls too low (hypoglycaemia) because they've had too much insulin or anti diabetes drugs. I'm sure your GP would gladly check urine and blood for diabetes to reassure you, but I'd cut out sugar loads anyway.

Meningitis jab safety

Q My child is due for her meningitis vaccination next week. I'm worried by reports of serious side effects. Is there any risk of her developing meningitis?

A The meningitis C vaccine isn't a live vaccine and can't cause meningitis or septicaemia (blood poisoning). It's made by combining the bacteria's sugar coating with a protein. The injection, which is safe for babies from two months upwards, gives long-lasting immunity. The jab can't kill your child but the infection can; 60,000 doses have been given worldwide without serious reactions and it's thought that 200 children's lives have been saved this year in the UK because of the vaccination campaign. If your daughter has a high temperature on the day or has had a previous serious reaction to any jab she shouldn't have one. You should discuss it first with your GP. Around 24% of children who have the jab have redness and swelling of the arm, and about 10% get a headache. Call the 24 hour helpline for information: 0845 600 0800

Termination truths

Q I am going to see a gynaecologist for some tests. Is there any way that he/she will be able to tell that I have had an abortion? I didn't go through my own GP for the termination and would prefer that it remains private.

A In general, a gynaecologist couldn't tell for certain. I would advise anyone to be truthful, because it may be relevant in the future. For instance, if you and your partner want to have a baby and find it takes a while, it will be highly relevant that you have already "proved" your fertility. Most GPs and gynaecologists don't bat an eyelid when someone says they've had a termination. I would urge you to give a full and complete history so you get a better service from them.

Breast cancer risks

Q My mother developed breast cancer when she was only 42. Thankfully, she is still alive and well today. I'm now in my 30s and becoming increasingly worried that I'm going to get it too. What tests can I have and when?

A I think you'll find statistics more comforting than platitudes. All UK women without breast cancer in the family carry a 1 in 11 chance of developing it - usually in old age. Our risk of getting breast cancer in our 40s is 1 in 100. With one relative like your mother, who was over 40 when diagnosed, your risk goes up to a maximum of 1 in 8 over your lifetime, and a 1 in 50 chance in your 40s. That's definitely odds against, so you are far more likely not to get breast cancer than to get it, and you are considered to be at low risk. Mammograms from 35, and referral to a specialist genetics clinic are recommended for high risk groups, such as women with two relatives diagnosed in their 30s. You'll obviously want to be aware of your own breasts by checking them regularly and will be invited for regular mammograms from 50, like the rest of us.

Defeating dandruff

Q What works best for dandruff? My wife's always brushing my shoulders and buying me new shampoos from the chemist. It can be very embarrassing.

A Two shampoos available over the counter are worth a try; Selsun and Nizoral. They work in different ways so try one first and switch if you have no joy. If your dandruff is accompanied by scaly skin patches, you may have psoriasis. It's worth a visit to your GP to discuss options.




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