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Suggest Treatment For Type 2 Diabetes
Brief Answer:
Four pronged approach
Detailed Answer:
Hello Mam. Thanks for writing to hcm. Noted the contents of your query. Newly diagnosed Type 2 diabetes is treated via a four pronged approach namely diet, exercise, education on diabetes and medications. It would be apt to see a qualified dietitian and gets customised diet plan based on your weight, activities and dietary preferences. Small changes made over time that should last a lifetime is the key here. Briefly speaking it would be apt to avoid refined sugars and high salt and oil based diets. Switch to low fat dairy. There are certain vegetables and fruits that can be taken in moderation and some in plenty. I feel a dietician would be the best person to customize it for you. Regarding exercise, if you are not into too much exercise presently please get a ECG and a tread mill test done to ensure your cardiac fitness is optimal prior to exercising. Aerobic exercises for abt thirty mins daily for five days a week with weigh training twice a week will do. You can walk briskly or swim or jog or use a tread mill or a stationary bike. Regarding education on diabetes there are plenty Of portals available online. Some good ones would be that from mayo clinic and the national institute of health. Please learn abt why diabetes occurs and its complications, role of diet and exercise and foot care. Regarding medications you should start with tab metformin 500 mg at night and increase it by one tablet weekly to a maximum of two tablets a day. That is 1 gm a day. Please check your sugars in the fasting state. It should be between 4.4 and 7.2. The glucose levels after two hr of meals should not exceed 10. If you maintain it so for a period of three months and then repeat your hba1c its likely it would have come down. If its not less than 7 inspire of a good diet, exercise and regular medications you will need modification of medications further. Please check your fasting lipid profile after glucose levels have settled. It would be also good to get your eye examined. Kindly consider doing serum creatinine and urine albumin to assess the kidneys, sgot and sgpt to evaluate for fatty liver. When time permits please see a podiatrist and get your feet checked when the nerve function and blood circulation will r assessed too. The reason why we are doing all this is because type 2 diabetes is quite asymptomatic in most patients but some patients can have complications at the time of diagnosis itself. We need to screen for it. Nothing to be alarmed. I understand all this information may be quite alarming but in diabetes knowing abt it completely is in itself such an important part of your treatment. Do not worry. You will just need to switch to a healthier lifestyle. With good glucose control you can have a healthy complication free life. I will be glad to answer any more doubts that you may have. Wishing you good health. Warm regards. Dr Praveen.
Four pronged approach
Detailed Answer:
Hello Mam. Thanks for writing to hcm. Noted the contents of your query. Newly diagnosed Type 2 diabetes is treated via a four pronged approach namely diet, exercise, education on diabetes and medications. It would be apt to see a qualified dietitian and gets customised diet plan based on your weight, activities and dietary preferences. Small changes made over time that should last a lifetime is the key here. Briefly speaking it would be apt to avoid refined sugars and high salt and oil based diets. Switch to low fat dairy. There are certain vegetables and fruits that can be taken in moderation and some in plenty. I feel a dietician would be the best person to customize it for you. Regarding exercise, if you are not into too much exercise presently please get a ECG and a tread mill test done to ensure your cardiac fitness is optimal prior to exercising. Aerobic exercises for abt thirty mins daily for five days a week with weigh training twice a week will do. You can walk briskly or swim or jog or use a tread mill or a stationary bike. Regarding education on diabetes there are plenty Of portals available online. Some good ones would be that from mayo clinic and the national institute of health. Please learn abt why diabetes occurs and its complications, role of diet and exercise and foot care. Regarding medications you should start with tab metformin 500 mg at night and increase it by one tablet weekly to a maximum of two tablets a day. That is 1 gm a day. Please check your sugars in the fasting state. It should be between 4.4 and 7.2. The glucose levels after two hr of meals should not exceed 10. If you maintain it so for a period of three months and then repeat your hba1c its likely it would have come down. If its not less than 7 inspire of a good diet, exercise and regular medications you will need modification of medications further. Please check your fasting lipid profile after glucose levels have settled. It would be also good to get your eye examined. Kindly consider doing serum creatinine and urine albumin to assess the kidneys, sgot and sgpt to evaluate for fatty liver. When time permits please see a podiatrist and get your feet checked when the nerve function and blood circulation will r assessed too. The reason why we are doing all this is because type 2 diabetes is quite asymptomatic in most patients but some patients can have complications at the time of diagnosis itself. We need to screen for it. Nothing to be alarmed. I understand all this information may be quite alarming but in diabetes knowing abt it completely is in itself such an important part of your treatment. Do not worry. You will just need to switch to a healthier lifestyle. With good glucose control you can have a healthy complication free life. I will be glad to answer any more doubts that you may have. Wishing you good health. Warm regards. Dr Praveen.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thank you doctor.
I am already taking galvus 1 gm and galvus 2 tablets before meals twice daily, yet my sugar is high between 250 at fasting in the morning and 300 to 380 rest of the day. Should I change my medication or dosage? will a short dose of insulin help? is it possible to get off insulin later?
I am not overweight at all about 52 kg and height 5 1. my diet is simple veg XXXXXXX food, no butter or sweets. lots of vegetables, a little permitted fruit and little oil. no smokind, drinking, pan, panmasala.
only poor habit is less sleep owing to overwork. hence not too much exercise. bp normal. the report i sent has my urea creatine and other readings too.
often get severe pain in calf and thighs. sometimes headache. eyes tested -- no problem so far.Also advised gloweye, benitec 40 and rosavus 10 1 each at night.
What can be done to bring sugar within acceptable readings?
I am already taking galvus 1 gm and galvus 2 tablets before meals twice daily, yet my sugar is high between 250 at fasting in the morning and 300 to 380 rest of the day. Should I change my medication or dosage? will a short dose of insulin help? is it possible to get off insulin later?
I am not overweight at all about 52 kg and height 5 1. my diet is simple veg XXXXXXX food, no butter or sweets. lots of vegetables, a little permitted fruit and little oil. no smokind, drinking, pan, panmasala.
only poor habit is less sleep owing to overwork. hence not too much exercise. bp normal. the report i sent has my urea creatine and other readings too.
often get severe pain in calf and thighs. sometimes headache. eyes tested -- no problem so far.Also advised gloweye, benitec 40 and rosavus 10 1 each at night.
What can be done to bring sugar within acceptable readings?
Brief Answer:
Change of medications
Detailed Answer:
Hi again. Noted all the details. The best option in your case would be to take a single shot of basal insulin like glargine or detemir at bedtime. You can start with 12 units and then check your fasting glucose every three days. You can increase the night dose by three units every three days until your fasting sugar is between 80-130. Once the fasting sugars are set the rest of the day will quite fall in place. Please continue Galvus 50 mg twice a day and also take metformin 1 gm in the morning and night and 500 mg at noon. All tabs after meals. You can continue rosuvastatin 10 mg at night. The rest of your lifestyle seems alright. Need to focus a bit on sleep and exercise. Can you try walking for five mins every two hrs while at work. If you work for 8 hrs a day it would amount to 20 MTS which itself is a good start. Please try to work on your sleep. Atleast 6 to 7 hrs is essential. Regarding control of blood sugars you can try other forms of tablets like glibenclamide and glimepride but at the expense of hypoglycemia and wt gain. Insulin has a lesser adverse effect on weight especially your basal insulin type I mentioned. It has more potential to bring down your sugars as well. Regarding stopping insulin later we cannot be certain. Not that it can't be but in most cases insulin will be required at some point in time which is due to the natural progression of the disease. Hope the answer helped. I will be glad to help out if there are any more queries mam. Warm regards.
Change of medications
Detailed Answer:
Hi again. Noted all the details. The best option in your case would be to take a single shot of basal insulin like glargine or detemir at bedtime. You can start with 12 units and then check your fasting glucose every three days. You can increase the night dose by three units every three days until your fasting sugar is between 80-130. Once the fasting sugars are set the rest of the day will quite fall in place. Please continue Galvus 50 mg twice a day and also take metformin 1 gm in the morning and night and 500 mg at noon. All tabs after meals. You can continue rosuvastatin 10 mg at night. The rest of your lifestyle seems alright. Need to focus a bit on sleep and exercise. Can you try walking for five mins every two hrs while at work. If you work for 8 hrs a day it would amount to 20 MTS which itself is a good start. Please try to work on your sleep. Atleast 6 to 7 hrs is essential. Regarding control of blood sugars you can try other forms of tablets like glibenclamide and glimepride but at the expense of hypoglycemia and wt gain. Insulin has a lesser adverse effect on weight especially your basal insulin type I mentioned. It has more potential to bring down your sugars as well. Regarding stopping insulin later we cannot be certain. Not that it can't be but in most cases insulin will be required at some point in time which is due to the natural progression of the disease. Hope the answer helped. I will be glad to help out if there are any more queries mam. Warm regards.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thank you for the detailed response doctor
But you haven't said what to do about my leg pain -- particularly calf and thighs. Sometimes I also get sever cramps --in the calf when sleeping. But more painfully, when I am awake, in my toes wheich then bend onver one another. At such times when my toes caramp, the pain is very sever and I cannot even straigten my leg.
Als of late my limbs - particularly hand below elbow and legs have become very thein. my legs have become like sticks and pain after even short walks. Has this got to do with diabetes? I am takinga vit D XXXXXXX every week and calcium tablets.
Also for the last 10-11 years (after onset of diabetes), my skin in the exposedportions is heavily pigmented. Does that have to do with diabetes, any deficiency or reaction to medication? skine specialists I consulted have not been able to help. The pigment spots are close together and numerous, do not itch or irritate.
But you haven't said what to do about my leg pain -- particularly calf and thighs. Sometimes I also get sever cramps --in the calf when sleeping. But more painfully, when I am awake, in my toes wheich then bend onver one another. At such times when my toes caramp, the pain is very sever and I cannot even straigten my leg.
Als of late my limbs - particularly hand below elbow and legs have become very thein. my legs have become like sticks and pain after even short walks. Has this got to do with diabetes? I am takinga vit D XXXXXXX every week and calcium tablets.
Also for the last 10-11 years (after onset of diabetes), my skin in the exposedportions is heavily pigmented. Does that have to do with diabetes, any deficiency or reaction to medication? skine specialists I consulted have not been able to help. The pigment spots are close together and numerous, do not itch or irritate.
Brief Answer:
could be complications of diabetes
Detailed Answer:
Hello again. The skin discoloration is definitely due to diabetes which is called diabetic dermopathy. Most patient have no trouble with it except for the cosmetic issues associated with it. There are skin lightening creams but most of them have steroids which are unsafe for you. Dont worry abt it. You need to mentally adjust to the look though. The pain in the thighs and legs could be due to neuropathy. There are many types of it. You probably have the sensory motor variety. There are medications like pregabalin, duloxetine and amitryptyilline which are useful. Nerve vitamins like methylcobalamin 1500 MCG a day and alphalipoic acid 600 mg twice a day are all medications that could help. You need to see a physiotherapist and work on improving the muscle mass and tone of your lower limbs. However since you are on replacements for vitamin d I would suggest go check the vitamin d levels. You have rather low hemoglobin levels which needs to be corrected with diet and also iron supplements. Along with that please try the medications I mentioned earlier. You could start with pregabalin 75mg at night and go up on the dose every two weeks until pain relief is fully obtained. I will be happy to help you with the drug titration. Plz take a tab of evion lc at night which is vitamin e with levocarnitine which is a vitamin as well that helps in cramps greatly. Likewise though your calcium levels are normal you need to take a tab of calcium with vit d daily. Take 50000 iu of vit d weekly for no more than 8 weeks and then monthly once. But take calcium and vit d tab as advised once daily. Please dont take iron and calcium at the same time as the absorption is affected. Take care of your health. Plz feel free to contact anytime. I will be happy to help. Warm regards. Dr Praveen.
could be complications of diabetes
Detailed Answer:
Hello again. The skin discoloration is definitely due to diabetes which is called diabetic dermopathy. Most patient have no trouble with it except for the cosmetic issues associated with it. There are skin lightening creams but most of them have steroids which are unsafe for you. Dont worry abt it. You need to mentally adjust to the look though. The pain in the thighs and legs could be due to neuropathy. There are many types of it. You probably have the sensory motor variety. There are medications like pregabalin, duloxetine and amitryptyilline which are useful. Nerve vitamins like methylcobalamin 1500 MCG a day and alphalipoic acid 600 mg twice a day are all medications that could help. You need to see a physiotherapist and work on improving the muscle mass and tone of your lower limbs. However since you are on replacements for vitamin d I would suggest go check the vitamin d levels. You have rather low hemoglobin levels which needs to be corrected with diet and also iron supplements. Along with that please try the medications I mentioned earlier. You could start with pregabalin 75mg at night and go up on the dose every two weeks until pain relief is fully obtained. I will be happy to help you with the drug titration. Plz take a tab of evion lc at night which is vitamin e with levocarnitine which is a vitamin as well that helps in cramps greatly. Likewise though your calcium levels are normal you need to take a tab of calcium with vit d daily. Take 50000 iu of vit d weekly for no more than 8 weeks and then monthly once. But take calcium and vit d tab as advised once daily. Please dont take iron and calcium at the same time as the absorption is affected. Take care of your health. Plz feel free to contact anytime. I will be happy to help. Warm regards. Dr Praveen.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thank you doctor
The medicines are available in different combinations and strengths. alphalipoic acid is available in 100 in combination with others but you have suggested 600 mg.
Can you please suggest suitable brands (preferably least cost) that will match the dosage suggested by you as it will make it easy for me to buy at medicine shops
Reg
The medicines are available in different combinations and strengths. alphalipoic acid is available in 100 in combination with others but you have suggested 600 mg.
Can you please suggest suitable brands (preferably least cost) that will match the dosage suggested by you as it will make it easy for me to buy at medicine shops
Reg
Brief Answer:
sure
Detailed Answer:
You are welcome mam. Well, you can get the medicine called tab thiotacid 600 mg which is alphalipoic acid. Take one tab in the morning and one at night. That should do. Take care. Warm regards.
sure
Detailed Answer:
You are welcome mam. Well, you can get the medicine called tab thiotacid 600 mg which is alphalipoic acid. Take one tab in the morning and one at night. That should do. Take care. Warm regards.
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Above answer was peer-reviewed by :
Dr. Prasad
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