DEAR DR. BLONZ: For years, my blood glucose has been in the “high-normal” range. The last couple of checkups showed elevated levels, though, and after some other tests, I was diagnosed as having Type 2 diabetes mellitus. I am 65, a bit overweight, with no family history of diabetes. I was advised to lose some weight, change my diet and do more exercise. I’m not clear about insulin resistance and how it relates to the different types of diabetes, so I am interested in your thoughts. -- F.S., Scottsdale, Arizona

DEAR F.S.: Glucose, the building block of carbohydrates, is a primary fuel for the body. It is the brain’s preferred fuel, and the only one that red blood cells can use. Entire body systems exist to help maintain blood glucose, but these systems don’t always work perfectly.

During digestion, dietary carbohydrates get broken down to glucose, which is actively absorbed into the bloodstream -- at which point it is often referred to as “blood sugar.” Glucose has a hard time getting into cells on its own. The missing factor is insulin, the hormone produced and released by the pancreas that serves as a passport to get glucose into most cells. (Insulin doesn’t help get glucose into the brain -- that’s a different story.) Once in the cell, glucose provides energy for all work, including muscle contraction, biosynthesis and repair. Once cellular energy needs are satisfied, extra glucose gets turned into lipids (fat), the most concentrated form of energy in the body. Packaged as triglycerides, these travel to storage in our fat cells.

Diabetes is present when there’s insufficient insulin to get the glucose out of the bloodstream and into the cells. Type 1 diabetes is when the pancreas is unable to produce and release insulin. In such cases, replacement insulin is given, usually by injection. More common is Type 2 diabetes; this occurs when the pancreas can still produce and release insulin, but can’t keep up with the demand, so blood glucose levels remain elevated. Treatment can include diet and lifestyle adjustments or medications to stimulate the pancreas to release more insulin. Type 2 diabetes used to be known as “adult-onset” diabetes because it was seen mainly in adults, but now it is prevalent in children, as well.

Here’s the connection between Type 2 diabetes and weight: As fat cells increase in size, they tend to become less sensitive to insulin. This insulin resistance means that the body needs more insulin to clear the same amount of glucose from the bloodstream. Obesity, in essence, can overwork the pancreas until it becomes unable to keep up. Between 80 and 90 percent of those with Type 2 diabetes are obese. This also helps explain why those with this type of diabetes often experience dramatic improvements when they lose some pounds and change the way they eat.

There are short- and long-term health risks if blood glucose remains elevated. The bottom line with any diabetic condition is to keep the glucose within normal limits. This can be done with diet, exercise and medication, along with regular monitoring of blood glucose levels. For more on managing diabetes, see b.link/wb6c3.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: I have heard that harmful changes can occur in water bottle plastic during heating in a microwave. While I don’t microwave these bottles, I have been opting to reuse them after washing, drying and refilling them with fresh water. After this, they are put in the refrigerator. As part of my treatment, I run the bottle’s neck under an instant hot water tap to sanitize it (even though I am the only one using these bottles). Would this be considered heating the plastic and therefore harmful? I drink lots of water and reuse plastic water bottles for their portability. I want to keep doing this but want your thoughts on this subject. Thank you. -- D.M., Phoenix

DEAR D.M.: Most commercially packaged plastic water bottles are designed for a single use. These bottles, or any plastic, for that matter, should not be put in a microwave unless it specifically states that it is microwave-safe. There is an underlying concern regarding re-use that consumers will not adequately clean and dry the containers between uses. There are bacteria on our hands and mouth, and they easily get on and in bottles when used. The failure to clean and dry properly makes the bottle a convenient breeding ground for potential problems. Consider also that the narrow mouths of commercially packed water bottles make them challenging to wash and rinse. My thought is it’s best to avoid this type of re-use. If, however, you are still planning to reuse plastic water bottles, here are some reasonable strategies -- but these are not a guarantee of safety.

Give the bottle a good visual examination to make sure it is not discolored, cracked or damaged. Using a safe water supply, wash your hands thoroughly to control for the presence of bacteria. Then carefully clean the bottle and scrub with hot, soapy water using a bottle brush; rinse, and air dry. Avoid sharing bottles where the contents come in contact with the hands or mouth, allowing the transfer of bacteria. If needed, label the bottles for easy identification. Keep the container out of the sun, away from heat. I am uncertain whether the hot water tap would cause any problems. Limit re-use to a few times, then send the bottle off to be recycled.

A better option would be to use water bottles designed for re-use. Stainless steel containers would be on the top of the list, and you can find some that are double-walled to help maintain the internal temperature. There are also reusable plastic bottles. Many reusables have larger openings to facilitate cleanings between use. If opting for a plastic bottle, best to verify that it does not contain BPA (bisphenol A), an industrial chemical linked to several health problems. The FDA has banned the use of BPA in containers used for babies and children.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: I was hoping you might spread the word about the National Organization for Rare Diseases (rarediseases.org). When a family member was diagnosed with a rare disease, NORD was the only place that had usable information. After that, I joined the organization.

NORD has pushed for many years to have the government give tax breaks and incentives to companies that develop “orphan” drugs, since rare conditions only affect a small percentage of the population. The group also has a database of all the current clinical studies for rare diseases. -- S.T., Concord, California

DEAR S.T.: I thank you for your note. NORD is an organization I became familiar with after a minor outpatient surgical fix resulted in a short-term total paralysis, which had the doctors stumped and my family climbing the walls with concern.

The procedure was a non-urgent repair of an umbilical hernia -- in other words, my bellybutton was not adequately anchored in the abdominal muscle wall. Typically a routine fix, this procedure requires a general anesthetic. But when I slowly awakened from anesthesia, I realized I was in a state of total paralysis: unable to move any muscle or even open my eyes to signal that I was awake. There was a tube still in place, breathing for me. How’s that for a rude awakening?

They use a ventilator tube to keep the airway open as part of this surgical procedure. A drug called suxamethonium chloride (Anectine) had been used to relax my muscles, particularly those of the throat, during the tube’s insertion. Because of the general anesthetic, I was already “out” when the Anectine was administered.

The body has an enzyme that breaks down this muscle-relaxing substance in a matter of minutes. But unknown to me, the anesthesiologist and the surgeon, this particular enzyme is deficient in my body -- so the muscle-relaxation effect lingered. After a lot of anxiety among family members in the waiting room and head-scratching by the doctors, they thought this deficiency might be the issue.

Needless to say, it was an ordeal, as I remained locked in my body, not knowing what was going on -- not to mention the discomfort of the breathing tube and all the health professionals hovering over me. I was awake and heard them talking. I desperately tried to send them a signal that I was awake. Focusing all my efforts to get my foot to move, I finally got it to jerk. One of the nurses noticed it and commented, but it was dismissed as a muscle twitch. “No, I am here!” I recall screaming in silence.

After a few hours, the effects finally began to wear off. Awake and back home, I began to look around for more information, and NORD was one of the few places that discussed “pseudocholinesterase deficiency” (the name of my condition). It can have a genetic element, so I encouraged my family members to be tested. I now have this condition listed on all my medical records for any health professional who might inquire. I have also registered with MedicAlert (medicalert.org), an organization that can provide medical info when we cannot speak for ourselves.

Stay well, stay informed, and be sure that health professionals have all the information needed to care for you and your family members. NORD, MedicAlert and proactively maintaining your online medical records all have my solid support.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.