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Lethargy and fatigue in a diabetic and hypertensive, smoking addiction - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Diabetes
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2308 Questions
Doctor :   hi
Doctor :   Dr.XXX here.
Doctor :   please proceed with your health query.
User :   Hi - Good morning Doc. I am XXXfrom XXX
User :   I am 43 yrs old , diabetic , take insulin 36+30 units (humalog 25) , have hypertension and take medicines
User :   I am a heavy smoker and drink 2 pegs every day
User :   these days i feel lazy and exaperated often
User :   is it a good idea to get a angiogram done as a proactive measure to check for any heart blocks
Doctor :   ok. when was the last sugar check done? what were the sugar levels?
User :   i had it done yesterdauy at home - fasting 150 , pp 1780
User :   sorry pp-180
Doctor :   ok
Doctor :   since when you are having the present symptoms?
User :   this has been for the past 1.5 months
User :   my medications are as follows
Doctor :   ok do you have chest pain, shortness of breath, palpitations, chest tightness?
User :   insulin 36 unit + glimisaf M2+ piolet 30 ; corbis 5 mg + coversyl AM - in the morning
Doctor :   when are the episodes worse?
User :   there is no gerenarl pattern -- i do feel breathless if i walk fast or run for a few 20-25 metres
Doctor :   how many cigarettes do you smoke per day? since when you have been smoking?
Doctor :   how much of alcohol do you consume per week?
User :   smoking for more than 25 years , currently 15 cigs a day
User :   alchohol -- 2 pegs a day
User :   i am in IT and mostly a chair job - no exercise
Doctor :   was any other blood investigations like LFT (liver function tests), lipid profile (cholesterol panel), HbA1C (glycosylated hemoglobin) tests done?
Doctor :   was any chest x-ray done?
User :   i had done it almost 6 months back - chest xray was not done
Doctor :   have you tried to quit smoking anytime?
Doctor :   what were the tests results?
User :   i do not recollect the exact meaures but hB1AC was not in the 3rd level - it was 2nd level
User :   i tried to quit smoking but have not succeeded
User :   there have been times when i dont feel like smoking -- but still manage to somke
Doctor :   ok
User :   what tests do you suggest
Doctor :   i would recommend you to go ahead with a physical examination with your doctor, along with a chest x-ray (to look for changes in lungs due to excessive smoking) and a TMT done (to rule out cardiac causes)
User :   ok
Doctor :   the results will show if your symptoms are originating due to lung causes or heart causes
User :   i understand
Doctor :   and then further tests can be thought about
User :   is gym bad for me
Doctor :   if the TMT comes positive option of angiogram can be discussed with a cardiologist
Doctor :   with your current symptoms, yes it is not advised
Doctor :   go ahead with breathing exercises
Doctor :   and more importantly, quit smoking and reduce alcohol intake
User :   i understand -
Doctor :   quitting of smoking itself will improve your symptoms to almost 50% in about a weeks time
User :   so it is best to consult a cardiologist and get xray chest PA, TMT done
Doctor :   that is after the consultation with your doctor
User :   got it - are there any nicotine patches or medications available which can aid quit smoking
Doctor :   if anything is found positive for cardiac side, then cardiologist consultation will be needed
Doctor :   yes there are nicotine patches available and nicotine chewing gums available, but first you need to reduce quantity of cigarettes
Doctor :   try and reduce 1 per day
Doctor :   once you reach to having 1-2 cigs per day, then go on with the nicotine patches to aid in stopping that also
User :   ok - that helps doc.
User :   Thank you very much Dr. XXXXXXXX - have a great day
Doctor :   is there anything else I can help you with?
User :   thanks - nothing for now - will get in touch later as required
Doctor :   thanks for consulting me. bye for now. all the best
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