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Headache, tiredness, muscle pain. Diagnosed with diabetes type 2, BP. Taking metaforte g, mixtard. What do you advise?

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Endocrinologist
Practicing since : 2004
Answered : 319 Questions
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Dear Sir,

I am furnishing my medical history as under:-
Brief Details: -

Diabetic (Type -II) - 20 Years
BP - 10 Years

• Vegetarian
• Non-smoker
• Non-alcoholic
• Age – 54 Years
• Weight - 79 Kg
• Height - 176 CM

TAB- METAFORTE G-853       1-0-1
INJ - MIXTARD 30/70       18-0-12
TAB - TELSARTAN AM 40MG       1'-0'-1
COLSPRIN 100 MG       1'-0'-0
TAB- PLOZ MF -15       0'-1'-0
TAB- ROSEDAY 10MG       0'-0'-1


My present problems are: -

(1)Head ache and uneasiness: - Since one year (ever little more) I am having headache, tiredness & sleepy and especially between 3.00 to 5.00 PM and sometime this tiredness may continue even after 5.00 PM and during this pain I find it very difficult to work. Even people who see me can easily make out from my face and ask about my health condition.

My BP is 120/77 and sugar is 210 RBS at 4.00 PM today.

My observation:-
a)When I am at home, this problem will be comparatively less.
b)I got my eye check-up done and confirmed that cause of headache is not due to eye sight and due this headache, I normally feel to take hot coffee and use headache balm.

My doubts?
Whether my medicines are on higher dosage?

(2)Mussel pain:- Once in a month or little less, I suffer from “Sudden Catch” during night in Knee portion (above heel) and when I get this “catch”, immediately I will get up and shake my leg and next day morning it will be normal.

Physical Activity:-
45 Minutes to One Hour walking daily, but due to this uneasiness, now a days I am skipping my walking very frequently and resulting my insulin dosage increased. (About 4 month back it was 14-0-6 units)

Details of food intake are: -

7.00 AM - Coffee and two Biscuit (WITHOUT SUGAR)
8.30 AM - Half cup coffee
9.30 AM - Two Chapatti with two cup Raw & boiled vegetable, D-Protin without milk.
11.00 AM - Half cup coffee with two Biscuits
12.30 No - One Fruit like orange, sweet lime etc
01-30 PM - One small cup rice with sambar & Two cup boiled & raw vegetable
3.00 PM - Half coffee with two Biscuits
4.30 PM - Half coffee again
7.30 PM – Some light snacks and coffee
10.00 PM - One cup rice with Sambar & Curd with little raw vegetable.
Nature of Work

Desk work with normal work related stress. Normally I have good sleep and once in a week or so I will have disturbed sleep.

I am enclosing my medical reports and request you to advise me on the same please.

Thanks and regards,
XXXXXX
Posted Wed, 1 May 2013 in Headache and Migraines
 
 
Answered by Dr. Om Lakhani 6 hours later
Hi XXXXXX

Thank you for you question.

I had a look at your reports and here are some important points

1. You Diabetes is NOT under control. You HbA1c is high in both your reports. This has to be below 7 however in your reports it has been on the higher side. We need to control this

2. Your Vitamin D is on the lower side, we will discuss this.

3. Your other reports are fine, you cholesterol is fine. Triglyceride is a little high but since you are taking Roseday, I wouldn't worry much about it.

Lets review your symptoms a bit. You have blood sugar is on the higher side of 210. Sometimes changes in blood sugars call osmotic symptoms like headaches , muscle pains etc. Muscle pain and what is known as 'Tension headache' is also result of Vitamin D Deficiency .

I would advice you two things

1. We need to get your diabetes under control. This is very essential . Since you are taking Premixed insulin 30/70 and multiple medications and still your diabetes is not under control , I would recommend you to take Multidose Basal bolus insulin . I would advice you to personally consult a good diabetologist or endocrinologist for diabetes control.

2. I would advice you to take Vitamin D supplements. There are Vitamin D sachets available which can be taken once a week. Works very well with my patients. You can request you family doctor to prescribe you the same

Once again a good control of diabetes is necessary.

Hope this answers you queries. If there is anything else, please feel free to contact me.

With Regards
Dr. Om Lakhani
Consultant Diabetologist.
Above answer was peer-reviewed by
 
Follow-up: Headache, tiredness, muscle pain. Diagnosed with diabetes type 2, BP. Taking metaforte g, mixtard. What do you advise? 38 hours later
Namasthe Doctor,

Thanks for your valuable advice and Yes sir, I have noted your advice on my sugar level:

Sir, can I ask few more clarifications please:-

a)Whether my sugar of 200 plus is the cause for my problem sir? I was under understanding that; sugar level upto 200 is okay okay situation.

b)Could you please explain me little more on “Multi dose Basal bolus insulin” like how it act and benefit from it and this is only for understanding please sir.

c)Can you comment on my Diet : though I am thinking of reducing coffee, but not able to do so, can you advise me whether intake of coffee is the reason for my problems?

d)Can you name for Vitamin D supplements which is already working with your patients?

e)Based on my last Annual medical Report, is it necessary to worry on my diabetic Neuropathy or it can be reversible on controlling my sugar level?

Sorry for asking too many questions sir.

Once again I have noted your advice for controlling my sugar level Sir

Best regards
XXXXXX
 
 
Answered by Dr. Om Lakhani 5 hours later
Namaste XXXXXX

Here are the answers to your questions

a)Whether my sugar of 200 plus is the cause for my problem sir? I was under understanding that; sugar level upto 200 is okay okay situation.

Answer : Sugar level of 200 is not okay . It is on the higher side. Fasting sugar <130 and post meal sugar <180 is acceptable. 200 is on the higher side. However, fluctuations in sugars can cause symptoms known as 'osmotic symptoms' which could explain your symptoms with high sugars.

b)Could you please explain me little more on “Multi dose Basal bolus insulin” like how it act and benefit from it and this is only for understanding please sir.

Insulin are of two types. One is long acting and other is short acting. Long acting ones control your fasting sugars and short acting ones control sugars after meals. Now your premixed insulin is a combination of short and long acting ones. Multidose insulin is where we use one long acting insulin and give short acting insulin whenever you take a meal heavy in carbohydrates (generally 2 or 3 shots of short acting insulin in a day)

c)Can you comment on my Diet : though I am thinking of reducing coffee, but not able to do so, can you advise me whether intake of coffee is the reason for my problems?

Sir you diet is alright. Coffee per se is not a problem in you case, however if you have been taking it since long, it can cause a little dependence and the time when you have not taken it , you will feel a little tired and down. So I would advice you to gradually reduce your dependence on coffee if possible.

d)Can you name for Vitamin D supplements which is already working with your patients?

Calcirol sachets and D3up sachets are some popular ones. They are taken once a week mixed with milk or water.

e)Based on my last Annual medical Report, is it necessary to worry on my diabetic Neuropathy or it can be reversible on controlling my sugar level?

Yes. Diabetic neuropathy can be reversed with good sugar control. Sugar control is prime importance in management of diabetic neuropathy.

Hope this was helpful

Please write in for any other questions.

Regards
Dr. Om Lakhani, MD.

Above answer was peer-reviewed by
 
Follow-up: Headache, tiredness, muscle pain. Diagnosed with diabetes type 2, BP. Taking metaforte g, mixtard. What do you advise? 18 hours later
Namaste Doctor,

Thank you very much sir, I am really re-gained my confidence with your clarifications, my head ache and giddiness was bothering me and thinking that I might be having some other problems, as such I have gone for various blood tests .

Sir, again I am bothering and hope you will not mind it sir:-

As advised, I have consulted my doctor and based on my blood report he has modified my medicines as under:-
Insulin:- H.Mixtard 50:50 for morning
H.Mixtard 30:70 for night (earlier it was 30:70 for both time)

Tab: - METAFORTE G-853 stopped & started “TRIVOLIB” 1-0-1
Tab: - PIOZ-MF reduced from 15MG to 7.50 MG for afternoon.

Sir, do you comment and little bit explain me on above changed medications and this is only for my confidence and understanding sir please.

Hope that my sugar level may come to control with the changed medications sir.

Do you advise any vitamin tab sir – my friend is taking Tab-BECADEXAMIN daily, in-fact I also taken for few days and stopped now, Can I continue sir.

Though I am trying to lose my weight, but could not lost, whether these medications and insulin also contributing to my weight gain sir?

Once again I am thankful to you for your guide and advise sir.

Best regards,
XXXXXX

 
 
Answered by Dr. Om Lakhani 10 hours later
Hi Mr. XXXXXX

The change in medications are alright. Trivolib contains voglibose that will reduce your sugar absorption. This will help you in reducing your late afternoon blood sugar. Only I would advice you to take it in before lunch and before dinner (i.e. 0-1-1 instead of 1-0-1). The change in Insulin is alright although I prefer giving one time basal insulin at night time and for post meal control I use other medications. However, these things depend on the judgement of doctor you are seeing.

You can take any multivitamin you prefer. I prefer using OPTISULIN which contains chromium which is though to be helpful for diabetics.

Amongst your medications, Insulin can cause a little weight gain but it is only minor. Pioz- MF will actually cause a little weight loss if anything. No I would say no they are not the prime reasons for your weight gain.

I hope this was helpful.

Regards
Dr. Om Lakhani.



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