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Suffering from diabetes. Can an online doctor suggest a clarification ?

Dear doctor, My wife is 63 years old and known diabeticn and BP patient for the past 20 years. We admitted her at the Columbia Asia in Bangalore. ECG and angiogram wer done. The doctor has written the following in the report. cvs - no. s3/rs-bil basal creps+/ ecg;AF with FVr/echo-TLS due to high HR, mild global hypo,ef-40%, mild LVDD, increased filling pressures, mild TR. CAG done showed same LAD-mild 6=-70% stenosis, LCX long segments 90% stenosis. She was prescribed tab Atrova 10mg.0--0--1/tab Aldactone 25mg 1-0-1/tab Cardarone 200mg 1-0-1/tab Acitrom 2mg 0-0-1/tab Amlong 10mg 1-0-1/tab Olvance 40mg 1-0-0/tab Lasix 1/2-0-0/tab Clopitab-A sd75mg 0-1-0/tab Pantodac 40mg 1-0-0/Formonide inhaler 2 puffs twice a day/Tiova inhaler once a day in the morning/ ivepred 4mg 1-1-1/tab Odimont LC one ag bed time. Human insulin 30/70 - 30 noon and 25u night/Human actrapid insulin 20u in the morning. Then she was discharged. After coming home her sugar has started to shoot up to 350 and 450. When contacted the doctors told that the Steriods which were given for her lung congestion could be causing the sugar level to shoot up and asked to stop the steriods. We were asked to report after five days. When we went to the hospital, the doctor has examined her and had written recent ACS two vessels CAD on medical rx/ AF with FVR on anticoagulation/DM &HTN/cvs-no s3/murmur/rs-clear/S.cret 1.44mg%/K+6.9meg/L/INR 7.53 and advised only Cardarone/ Amlong/Cardivas/Atrova and Pantodac and advised to see a Nephrologist . He has advised K-Bind 30mg in 50ml watertwice a day and asked to get the tests US/ABD, URINE R/24Hr.Urinary Prot, Cal, Phos/KFT. The tests revealed the follownig: SERUM CREATININE(Alkaline picrate):1.46mg/dl/SERUM POTASSIUM(ISE Indirect) 6.7mmol/L/Glycosylated Haemoglobin (HbA1c)(EDTA)(HPLC-D 10) 13.6% and at the Haematology lab Prothrombin time (PT):84.7 Sec/ Control 11.3 Sec/INR 7.53.Again in the Biochemistry lab the 24 hr Urine protein--195mg/24hrs/Serum Calsium (ISE indirect 9.1 mg dl/ Inorganic phosphorous: 3.3 mg/dl and Kidney Function test showed Serum Sodium 126 mmol/L/ Serum potassium 4.2 mmol/L/Serum Chloride 100 mmol/L/ Seri, Urea (Enzymatic rate) 30 mg/dl - Serum Creatinine (Alkaline picrate)0.78 mg/dl and Serum Uric Acid (Colorimetric) was 4.88 mg/dl. Urine examination revealed pH 5.0/ Specific gravity 1.010 and Chemical examinatin revealeld Protein, Glucose, Bilirubin, URO Bilinogen, Ketone Bodies and Nitrites to be negative. Microscopic examination revealed Leukocytes: 2-3/hpf. Erythrocytes: Nil/hpf, Epithelial cells: 6-8/hpf, Casts Nil and Crystals Nil. This is the complete hospital history I have placed before you. Dear Doctor kindly tell me what exactly is wrong with her. Had she had heart attack? What is her current status. Now her BP and sugar has normalised Please advise. Regards Hemachandra
Asked On : Mon, 29 Aug 2011
Answers:  2 Views:  161
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General & Family Physician 's  Response
Dear Hemchandra,
Welcome to Healthcaremagic
Your wife has recently suffered from acute coronary syndrome and looking at history risk factors and documented poor ejection fraction of heart and use of anticoagulants, it is heart attack in your language but the treatment is very appropriate. No one can actually predict the long term prognosis and she needs very regular checkups with endocrinologist, cardiologist and nephrologist. She needs a close and frequent monitoring.
Take care.
Answered: Mon, 29 Aug 2011
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Diabetologist Dr. Amit Rajput's  Response
Dear Mr. Hemchandra,

From the history you have typed, I can assume few things:-

She has Irregular heart beat
Blood supply to the heart is not adequate (as is expected in most of the very long standing diabetics)
The angiography shows couple of blocks in the blood vessels supplying the heart

Shooting up of her sugars could either be due to:-

Inadequate insulin
Recent change in diabetes medications
Stress on heart
Steroids seem to be least likely cause of raised sugars as they are inhaled and not oral.

She also has chronic kidney disease, which also is common in long term diabetics.

She is getting right treatment. I advise you to keep a regular followup with your physician.

Answered: Tue, 30 Aug 2011
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