STU

DEAR DR. ROACH: I quit smoking about six months ago and was able to resist the temptation to smoke again because I took up vaping immediately afterward. Thanks to vaping, I think this time I will be able to stay off of cigarette smoking permanently after unsuccessfully quitting a half dozen times over the years. I recently read some very alarming news reports about lung disease among vapers, which has me very worried. I do not want to stop vaping, for obvious reasons. Can you please advise on whether vaping is safe for me to continue? — J.B.

ANSWER: Vaping uses a device with a battery and heating element to vaporize a liquid, usually containing nicotine, flavoring and chemicals to make the aerosol. Vaping is highly prevalent among younger adults, with over 20% of high school students reporting use in the previous 30 days.

Some people use vaping to quit smoking, and it is as effective or more so than nicotine replacement, such as patches or gum. However, 80% of people who quit smoking continued to vape at one year. Unfortunately, many of the young people who start vaping are doing so without ever having been a smoker.

Most data suggest that vaping is safer than smoking. However, there are no long-term data to really support this. There are many chemicals produced in vaping, and their effect on the lung isn’t well-established, but the nicotine most e-cigarettes contain (even some labeled as containing no nicotine) is certainly dangerous to blood vessels. In August of this year, a death was reported in Illinois attributed to vaping, along with hundreds of people reporting a lung illness that one lung expert likened to a chemical inhalation injury. As of this writing, the underlying mechanism for this outbreak of lung disease associated with vaping is unclear.

I cannot tell you whether vaping is safe to continue. I think it is still very likely to be better than continuing to smoke cigarettes, but there is no doubt in my mind that stopping vaping would be best. Perhaps at this point, a traditional nicotine replacement regimen might be helpful for you to help you stop vaping with less risk of going back to smoking.

DEAR DR. ROACH: I am 75 and have Type 2 diabetes. I take metformin and glipizide. If my blood sugar is high, should I lie down and rest or get up and move around? What is the best way to prevent high blood sugar? — K.P.

ANSWER: Type 2 diabetes is mostly a result of insulin resistance, which has several treatments. One is giving more insulin; insulin shots do that, but the glipizide you are taking signals your pancreas to make more insulin. Another is making insulin work better, and many of the newer drugs do this. Metformin tells your liver not to make sugar, and another medicine — canagliflozin (Invokana) — causes your kidneys to lose sugar through the urine.

However, perhaps the two most important ways are to not take in so much sugar through sweets or starches through bread, rice and pasta. Your body quickly turns these to sugar. The other is to exercise, which both uses sugar in the muscles but also acts against the insulin resistance.

If your sugars are consistently high, work with your diabetes specialist and a nutritionist dietitian to come up with a plan to keep your blood sugar from getting too high.

At age 75, it’s also important to prevent blood sugars from getting too low, so your diet, exercise and medications need to be properly regulated together.