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Do I need fast acting insulin to control weight loss?

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Diabetologist
Practicing since : 1973
Answered : 23 Questions
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1.I was diagnosed with high blood sugar 5 months back my HBA1C was 10 at that time. Now after diet control my HBA1C came down at 5.6 . But I lost so much weight. My fasting BG now remains at 80 but post meal sugar reaches upto 180.
2.My height is 5.8 and wight 63 Kg (lost 10 Kg in last 10 months)
2.Do i need fast acting insulin to control this. I cant reduce my diet further as I dont want to loose weight.
3.I am also taking Cardace 1.25 mg since 5 months and my blood pressure is well under control.
4. My mircroalbumin / creatine levels were 1.72 mg/g. Is this test is sufficient to
Diagnose any kidney problem.
5.My LDL is 131 . Do i need any medicine for this.
6.My GAD antibodies were 5.6 (negative)
7.My grandmother , father , maternal aunts , cousines all are suffering from diabetes of same level are we suffering from MODY.
8.Shall i start taking fast acting insulin or what do u advise me for my future course of action.
Posted Sun, 29 Apr 2012 in Diabetes
 
 
Answered by Dr. L K Shankdhar 5 hours later
Hello XXXXXXX

Thanks for posting your query.

You do not need fast acting insulin for this range of blood glucose levels.

Also please do not further reduce on your diet.

Your creatinine levels seem to be normal. But you need to undergo a complete renal profile test to diagnose any kidney problems.

You do not need medication for LDL level of 131. Please do restrict your fat intake.

Yes indeed, it seems like all of you and your family members are suffering from MODY.

Weight loss might be due to undue restrictions in your diet. You should contact some dietician and ask her to make a diet card with following specifications:

Calories required: 2200/day

Carbohydrate: 60%

Protein: 15%

Fat: 25%

I Still suggest you to get a thyroid profile done.

You can also add a tablet of Pioglitazone (15 mg) to your regular medications. Please discuss this with your treating doctor.

Hope I have answered your query.

I will be available for your follow up queries if any.

Regards,









Dr. LK Shankhdhar
Above answer was peer-reviewed by
 
Follow-up: Do I need fast acting insulin to control weight loss? 1 hour later
Dear Sir,
Thanks for your reply , I just want to clearify one thing -
1.The value 1.72 mg/g i mentioned above is Mircroalbumin / Creatine ratio in my urine. My creatinine level in blood is 0.97. serum albumin - 5.5 , BUN-24 Elecrolytes are normal , for complete kidney profile what other test you recommend.

2.In your diet you mentioned protein 15% while Fat 25% . I initially thought I should have more proteins and less fat. As per you what is the major risk factor for me , My LDL level or my kidneys . Because I believe protein is a concern on during kidney disease.

3.You mentioned I should take Pioglitazone which is an insulin sensitizer. I am a thin person with abnormal sugar levels .My fasting blood insulin level came out to be normal. Do you think I am insulin resistant or insulin deficient. Shall I do post meal insulin level test at the time when my sugar level is high to confirm this. I am also taking Ramipril tablets , as per you how will it be ok to take pioglitazone with ramipril tablets .

4.My post meal sugar level reaches upto 180 which sometimes cause me to urinate frequently which results in further weight loss. Will this sugar level for next 10 year will cause any complications for me.

5.With due respect to all doctor's fraternity , why most of the doctors dont recommend insulin , I beleive insulin is best treatment for diabetes with no sideffects & I think I can gain weight with this. While other medication will have some sideeffects.

 
 
Answered by Dr. L K Shankdhar 12 hours later
Dear XXXXXXX

Thanks again for following up.

I have gone through your follow up query and want to offer following comments:-

1. Your ACR is 1.72 micro gram/gram which is normal since in men abnormal is -/>2.5. I calculated your estimated glomerular filtration rate by MDRD formula and it is 60 ml/ml/1.73 sq M, which is normal and a very relaible indicator of nephropathy. Your S. Creatinine is 0.97 mg% which is also normal. Blood Urea Nitrogen (BUN) however is 24 mg% which is slightly higher. It needs to be rechecked. Thus your renal involvement is questionable

Some recent studies have revealed that 50% patients of diabetes never have any albuminuria and they land up with chronic renal failure while 50% have albuminuria for whole life and their kidneys never fail. So under these circumstances , I don't feel any need to restrict protein in diet

You have asked about more tests required to establish renal status, I have already mentioned e-GFR

2. Regarding 25% fats in presence of LDL as 130 mg%, dietician should give <10% saturated fats and rest as monosaturate fats which don't raise LDL

3. Insulin resistance is always a part in evolution of diabetic status and I still feel you need Pioflitazone; remeber Pioglitazone also reduces albuminuria.

4. I will prefer Post meal level to be below 140 mg% and even slightly raised PP is expected to be detrimental.

5. Regarding choice of to Insulin, your impression as to Insulin is too rosy.
Insulin too has many side effects and is not the best drug; biggest hazzard being likelihood of low sugar which is most with Insulin besides undue and persistent weight gain which might be unwanted, even in your case beyond a certain point. Insulin does not improve disease process and has no Cardio vascular benefits.

Hope this much should suffice, Should you have more queries, I will be pleased to answer them as well.

Wish you good health.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Do I need fast acting insulin to control weight loss? 5 hours later
Dear Sir,
My most of the queries are now resolved , but still have some doubts on few points -

1.I have checked so many places on on net , and it is mentioned that for men normal mircroalbumin/ creatinine ratio is below 17 mg/g . And microalbuminuria is considered when it stays persistently higher than 30 mg/g .Mine is 1.7 mg/g. You mentioned it should be below 2.5 mg/g . Please clearify which one is correct.

2.For kidney test will eGFR is sufficient i.e will it include all blood & urine test which tells about any sign of kidney disease. When is the best time to give the urine sample is it first morning urine , second morning urine or random will also do.

3.Regarding LDL i have already reduced saturated fats and I m taking only monounsaturated fats. But i eat 2 eggs daily , now eggs contain cholestrol. As per you Which will contribute more towards increasing LDL is it dietary saturated fat or dieatary cholestrol. I desperately want to gain some weight please dont tell me to stop everything as I already have very few choices.

4.Regarding post meal sugar level below 140 . You must have treated so many diabetic patients some type 1 some type 2 as per your experience how many are able to achieve blood sugar levels below 140 all the time.

5.ADA recommends post meal sugars to be below 180. I know it is XXXXXXX But as per you why they are recommending such a high level r they foolish or stubborn or they dont know whats going around in the world.

6.Regarding insulin - If i take small doses of say about 0.5 unit or 1 unit . Can it cause hypoglycemia.Can i take insulin initially to gain back some weight than stop it.
 
 
Answered by Dr. L K Shankdhar 18 hours later
Dear Friend find clarification for all your doubts:-

1.I have checked so many places on on net , and it is mentioned that for men normal mircroalbumin/ creatinine ratio is below 17 mg/g . And microalbuminuria is considered when it stays persistently higher than 30 mg/g .Mine is 1.7 mg/g. You mentioned it should be below 2.5 mg/g . Please clearify which one is correct.
It is a matter of of units used: What I quoted was in milli gram/milli mol (mmol) and then normal for women is 3.5 milli gram/milli mol and for men is 2.5 milli gram/milli mol
When albumin is measured in micro gram and creatinine in milli grams, normal for women is >25 micro gram of albumin/milli gram of creatinine and for men >17 micro gram of albumin/milli gram of creatinine
Your reading being 1.7 micro gram of albumin/milli gram of creatinine is much lesser that 17 micro gram/milli gram so it is normal.


2.For kidney test will eGFR is sufficient i.e will it include all blood & urine test which tells about any sign of kidney disease. When is the best time to give the urine sample is it first morning urine , second morning urine or random will also do.
GFR mean Glomerular Filtration Rate. Glomeruli are the structures which form urine and in simpler words I can say, rate of urine formation is indicated by GFR. It is not calculated form any sample such as blood or urine. It is calculated from a formula called MDRD (modification in diet for renal disease). It needs level of serum creatinine, age and sex. Then it can be calculated from a calculator on net; weblink being:-
WWW.WWWW.WW

3.Regarding LDL i have already reduced saturated fats and I m taking only monounsaturated fats. But i eat 2 eggs daily , now eggs contain cholestrol. As per you Which will contribute more towards increasing LDL is it dietary saturated fat or dieatary cholestrol. I desperately want to gain some weight please dont tell me to stop everything as I already have very few choices.
For diet, I have already referred you to a dietician. She knows all about Mono unsaturated fatty acid (MUFA) and Poly unsaturated fattly acid (PUFA). On one had you say you are taking only MUFA and on the other hand you are taking 2 eggs a day; yellow of which contains mostly cholesterol which raises LDL


4.Regarding post meal sugar level below 140 . You must have treated so many diabetic patients some type 1 some type 2 as per your experience how many are able to achieve blood sugar levels below 140 all the time.
International Diabetes Federation (IDF) and European Association for study of Diabetes (EASD) have recommended PP as <140 mg% which compares to A1c <6.5% . As far as achievability is concerned, I don’t have figures for Indian patients, even in XXXXXXX and even 180 mg% of PPBG, comparable to A1c <7%, is achieved by only 38% patients while is Canada 50% achieve it.


5.ADA recommends post meal sugars to be below 180. I know it is XXXXXXX But as per you why they are recommending such a high level r they foolish or stubborn or they dont know whats going around in the world.
These are 2 different views and I should not comment upon why. As far as danger is concerned, it depends upon the drug used. With Insulin and Sulfonyl Urea group of medicines, risk of hypoglycmeia is high but with Pioglitazone risk is almost nil.


6.Regarding insulin - If i take small doses of say about 0.5 unit or 1 unit . Can it cause hypoglycemia.Can i take insulin initially to gain back some weight than stop it.
How can you measure 0.5 Units of Insulin. In western countries, even syringes are available which can measure 0.5 Unit of Insulin but not in India. Here minimum amount to be measured with syringes is 1 Unit. One Insulin pen is available in India from Elli XXXXXXX called Humapen Luxura, which can measure 0.5 Unit of Insulin. I have already spoken against use of Insulin in your case and stick to it.

Hope it answers all your doubts.

Wish You Good Health.
Dr. LK Shankhdhar
Above answer was peer-reviewed by
 
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