Q1: My 60-year-old husband has had diabetes for over 10 years and recently complains of lower back pain. Could this be osteoporosis?
A: Osteoporosis itself typically has no symptoms since bone nerves are only present in the periosteum – pain usually only occurs after fractures. However, a 2019 PLOS ONE study from the University of Sydney showed diabetics have a 35% higher risk of lower back pain than non-diabetics, though the exact mechanisms remain unclear.
According to the 2025 ADA Clinical Guidelines, bone density scans (DXA) are recommended for:
- All diabetics ≥65 years
- Postmenopausal women or men aged 50-65 with any of these risk factors:
- Frequent hypoglycemia
- Diabetes duration >10 years
- Using TZDs, SUs, or insulin
- HbA1c >8%
- Microvascular complications (neuropathy, retinopathy, nephropathy)
- History of falls
- Corticosteroid use
Important medication risks:
- TZDs (e.g., Actos, Avandia): 123% increased fracture risk after 1-2 years in women
- Sulfonylureas (e.g., Amaryl, Diamicron): 30% increased risk
- Insulin: 49% increased risk
Recommendation: Your husband should get a DXA scan. While general populations start osteoporosis treatment at T-score ≤-2.5, diabetics should begin at ≤-2.0.
Q2: My mother’s fasting glucose is normal but her HbA1c keeps rising (8.2% → 8.4%). Her doctor says postprandial glucose is the issue, but she already eats very plainly. Would further dietary restrictions cause malnutrition?
A: Diabetes nutrition has three key goals:
- Achieve weight targets
- Optimize glucose, BP, and lipids
- Prevent/delay complications
Common misconceptions:
- Many believe avoiding rice/sweets prevents high glucose but overlook other carb sources like:
- Root vegetables (sweet potatoes, taro, potatoes)
- Legumes (red/green beans)
- Corn, oats, etc.
Practical solution: Use the ADA Diabetes Plate Method:
- ½ plate: Non-starchy veggies (leafy greens, broccoli, onions, eggplant, etc.)
- ¼ plate: Lean protein
- ¼ plate: Quality carbs (whole grains)
Seasonal considerations:
A 2023 study of 137 T1D patients using CGMs found:
- Worst control: November-February
- Best control: April-August
The CDC notes three winter-related factors raising glucose:
- Cold stress → Increased stress hormones → Insulin resistance
- Flu season (peaking Dec-Feb) → Inflammation + stress hormones
- Holidays → Disrupted meal routines + reduced activity
Cultural context:
Even “light” traditional foods like spring rolls (runbing) or herbal cakes (caozaiguo) – originally eaten during China’s Cold Food Festival – can spike glucose if overconsumed.
Recommendation:
Consult a registered dietitian who can:
- Assess actual carb intake
- Evaluate for muscle loss or other conditions
- Create a personalized plan preventing malnutrition while optimizing glucose control
Key Takeaways:
- Back pain in diabetics warrants bone density evaluation
- Seasonal glucose fluctuations are normal but manageable
- “Plain” eating ≠ proper diabetes nutrition
- Professional dietary guidance prevents both high glucose AND malnutrition
Have more questions? Leave them in the comments below!
Medical Disclaimer: This content is for informational purposes only and should not replace professional medical advice.