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Feel chest discomfort. Have diabetes. Lost weight, sugar controlled taking metformin. Have fatty liver enlarged. What to do?

Hi,
Last year, I had diagnosed with high sugar. I am a male.My age is 32.My height is 5'10". My weight at that time was 89 Kg with major weight around waist and on tummy.I took metformin 500mg for three months on doctor's advice.I lost 19 kg of weight in 9 months period. My sugar level is now under control.Hb1ac is 5.2. sugar level (f 78 and pp 109). I have fatty liver and it is bit enlarged. My lipid profile : ldl is 151,HDL is 43, TCH 231, triglyceride 158, vldl is 145. Often, I feel sensation of blood flow in my back and sometimes i feel discomfort in chest. My doctors suggest diabetic diet and 45 min of regular walking and nothing else. What should i do now.
Asked On : Sat, 13 Apr 2013
Answers:  7 Views:  102
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Internal Medicine Specialist 's  Response
Hello!

Thanks for query.
Your sugar level is in good control hence continue with the diabetic diet and exercise.

Though you have reduced weight,lipid profile still deranged and that needs to be treated with statins like rosuvastatin or atorvastatin.

Get an ECG done and check blood pressure for chest discomfort.

Continue the treatment that your doctor has advised.
Hope you get relieved soon.

Wish you good heath.
Answered: Sun, 14 Apr 2013
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General & Family Physician Dr. Pavan Kumar Gupta's  Response
Hello,
Type 2 diabetic patients have two to four fold higher chances of developing coronary artery disease and cerebrovasular disease as ompared to non diabetics.This higher prevalence is seen even in those patients who achieve persistent tight blood sugar control.It is believed that co existing dyslipidemia significantly contributes to higher prevalence of macro vascular disease and thus needs to be aggressively managed along with hyperglycemia and hypertension,if present.
Do the following..
1... Get cardiac evaluation done by a cardiologist.
2... Your doctor has rightly advised for a diabetic diet and regular aerobic exercises for 45 minutes a day.
3... Since your total cholesterol and LDL cholesterol are high,you must take a statin drug.Target level of LDL in a diabetic is below 80 and it may not be achieved by only exercises.So a statin must be added.
Talk to your doctor regarding this.
I hope it helps.
Thanks
Answered: Sun, 14 Apr 2013
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Internal Medicine Specialist Dr. Akhilesh Dubey's  Response
Hi,
Welcome to HCM,
After going through your history, it is very good that you you have reduced weight and brought your blood sugar under control.
Now your time to maintain the same discipline in diet and exercise to keep it under control in long run. If you do not take care of diet and exercise patients tend to regain weight.
Your Lipid profile is deranged and you have fatty liver so continue on diet control and if required Statin may be given if it remains high especially LDL.
As you have Fatty liver by chance if you take alcohol please avoid it completely and if your doctor agree OBT( Oral Bile acid Therapy) by UDCA) may be given to improve fatty liver.
You have chest discomfort then get a EKG and if normal a TMT to be sure we do not miss anything.
Please continue diet and exercise and periodic check up of FBS,PPBS and HbA1c at periodic intervals. May be Lipid profile twice a year.
Please take care.
Good Luck.


Answered: Sun, 14 Apr 2013
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Internal Medicine Specialist Dr. Mayank Bhargava's  Response
Jan 2013
Hi,
Thanks for posting your query.
With the available described symptoms, there appears to be increased weight induced fatty liver along with diabetes.
Central obesity causes insulin desensitization with available insulin is not able to work on cells.
Your lipid profile is also uncontrolled.
Treatment of Dyslipidemia (deranged lipid profile) is decided by presence / absence of risk factors.
Smoking, age > 45 years, sedentary life, first degree relative with positive early heart disease 140/90 mm Hg, Diabetes are considered as risk factors.
Treatment of Dyslipidemia is decided by LDL level and should read ATP III guidelines.
If
If > 2 risk factors with 10 year risk of developing heart disease is
If > 2 risk factors with 10 year risk of developing heart disease is >20%, diabetes then LDL should be
Your LDL must be 70mg%.
Life style modifications are required in your case.
You should take low fat diet and live physically active life.
Life style modifications are required in your case.
You should take low fat diet and live physically active life.
Take care,
Dr. Mayank Bhargava
Answered: Sun, 14 Apr 2013
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Internal Medicine Specialist Dr. Omer's  Response
hi
you are having type to diabetes or metabolic x syndrome.......pain in back with chest pain can be coz of
1.anxiety of being diabetic at young age
2.diabetic neuropathy
3.metformin induced decrease in vitamin b12 absortion and leading to neuropathy
4 your tgs are high .....need strict diet control
take care
Answered: Sun, 14 Apr 2013
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Diabetologist Dr. Pratap VGM's  Response
DEAR SIR/MADAM

IT IS BETTER TO MAKE TAB. METFORMIN 500 MG TWO TIMES A DAY FOR THE REST OF YOU TREATMENT.
SINCE HBA1C IS ON BETTER SIDE AND LDL LEVEL IS SLIGHTLY INCREASED IT IS BETTER TO START ATORVASTATIN 10 MG AT NIGHT TIMES.
THE COMMON SIDE EFFECTS ENCOUNTERED WITH METFORMIN IS HYPERACIDITY. YOU CAN START A PROTON PUMP INHIBITOR LIKE TAB. PANTAPRAZOLE 40 MG BEFORE FOOD.


Answered: Sun, 14 Apr 2013
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General & Family Physician Dr. Het Ram Bishnoi 's  Response
Sep 2013
Hello, thanks for the query.
Here your's Hb level is 5.2 ( very low) VLDL is very high, sugar level is also normal.
Your's age is 32 yrs and weight is under control. Usually we prescribe Metformin in obese patient ( diabetic ) .
In your case I doubt you were the patient of diabetes. If you eat sugar product just 2-3 yrs before blood testing and get blood test there will high level of sugar in blood.
Any how now according to you your blood sugar level is normal .
Mind it that from today you get examination of your blood sugar level after every three month to rule out diabetes.
Regular exercise is very nice, you can walk but very rapid (fast) walking gives benefits.
In my opinion you take normal diet. Good luck. Dr. HET.
Answered: Sun, 14 Apr 2013
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