DEAR DR. ROACH: I’m a 70-year-old woman. I have Type 2 diabetes, and my morning fasting blood sugar numbers are all over the place. It’s very frustrating. I take glipizide and metformin. Could you tell me how to correct the numbers? — L.C.

ANSWER: Unfortunately, I can’t give you specific advice without a whole lot more information, but I hope some general advice will be helpful.

First, I’m not sure what you mean by “all over the place.” Fasting blood sugars in a person with diabetes are ideal when they are between 70-130 (or so) mg/dL, which is a broad range. If you are having consistently lower numbers, this might indicate that you are taking more medication than you need. A hemoglobin A1C level will help determine your overall control and is an essential first step.

High morning blood sugar levels can mean inadequate blood sugar control, but it can also mean a reaction to early morning hypoglycemia (having too low blood sugar). The use of continuous glucose monitors is making a dramatic change in the way we monitor blood sugar and adjust medication, although insurance often pays for it only when a person with Type 2 diabetes is on insulin and has low blood sugar.

Glipizide is no longer a first-line treatment for Type 2 diabetes, especially in older adults, as there is a higher risk for low blood sugar with this medicine than with most others. Sometimes a person does really well with it, but most of the time, newer alternatives provide better blood sugar control with less risk of low blood sugar. They also provide more of a benefit to your heart and blood vessels.

Lifestyle changes remain the most critical intervention for Type 2 diabetes, and you can get lots of help from a diabetes educator and a registered dietician. Many times, improving diet and exercise allows a person to stop some, or occasionally all, of their diabetes medicines.

DEAR DR. ROACH: Regarding PSA tests, digital rectal exams (DREs), and prostate cancer screenings, there is one component that I would like to ask about that affects almost every man who has a UTI specifically. The one component that affects many men somewhat differently than others is a prostate massage. Is this something that is no longer practiced?

Urologists are refusing to perform this treatment, which has helped many men for years and was considered a standard procedure for decades. Prostate stimulation helps cure the UTI infections along with medication. What legal justification justifies a doctor’s refusal? — S.B.S.

ANSWER: The evidence suggests that prostate massages are not effective when treating prostate infections. (I think you meant prostate infection/chronic prostatitis — also called chronic pelvic pain syndrome — rather than urine infections, since prostate massages were never used for urine infections. Meanwhile, they were certainly used as a treatment for chronic prostatitis when I was in medical school back in the 1980s.)

The theory was that prostate massages helped unblock the gland by getting rid of dried-up secretions in the prostate tubules. Since it’s probably ineffective, it’s no longer used. No legal justification is needed. If a physician feels that a treatment is ineffective, they are under no obligation to provide it.

A prostate massage is still used as a diagnostic test. The urine is sampled initially, then repeated after a prostate massage. A significant increase in white blood cells in the urine supports the diagnosis of a prostate infection. Most men find this uncomfortable.

A prostate massage also increases the PSA level, so if prostate cancer screening is recommended, it is usually obtained before a prostate massage.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved