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Why and how did my blood sugar levels stabilize post dengue ?

Hello Doctor My name is Nitesh telecommunication Engineer, male 39 yrs, height 183 cm weight 80kg. On april 5th 2010 I was diagnosed with very high blood sugar 550mg/dl. Cortisol 28 Iul and Insulin 3.6 ,I lost weight from 92kg to 82 kg in 20 days due to ketoacidosis . My doctor put me on metformin 500mg twice daily and DPP4 inhibitor Januvia 100mg daily once. Within 20 days my fasting sugars were down to 120. My cardiac profile and Liver profile were normal with no evidence of retinopathy , neuropathy or nephropathy, After two months of medication I suffered severe nephropathy, I had to go to urinate every 15 mins upto 30 times a day with great pain in the urethra, A sonography was performed on my bladder with no findings, Urine reports and urine culture also were negative, I had to take roliten 2mg for one month after which situation improved. On 10th Aug 2010 I and my father were admitted to The ICCU of Lilavati Hospital Mumbai with Dengue hemorragic fever, My father expired, My liver enzymes were above 9000 bilirubin above 10 So I had severe jaundice and I was bleeding through urine stools, nose and ear, Any-how I survived. My ICCU doctor stopped all diabetic medicines citing liver damage. On discharge I was advised insulin if necessary but no medicines. Post discharge I was 74 kg, so I lost 18 kg From 92 to 74. I have been measuring my blood sugar 4 times a week regularly with a very accurate Bayer meter. Post discharge my fasting sugars were always 95-100 and post lunch 109-137. On discharge my hemoglobin was 7.0 which I recoverd to 13 in 40 days. Afer Dengue it is 20months today and I have over 20 lab reports and 300 blood sugar readings on my meter but I have never crossed the above readings. I have 4 HbA1c readings which were 5.3, 5.0, 4.9 and yesterday it was 5.0. can you throw light as Why and how did my sugars stabilise post dengue. Pre dengue my hemoglobin was always above 15.0 and post dengue it has never risen above 13.0. I am 80kg today and physically fit and fine than before. Why doesnt My hemoglobin rise back to 15 as before. What may be the cause of the nephropathy attack 3 months after a sugar level of 550mg/dl ? I have got ample lab reports to support all the above phenomenon. Please put some light
Asked On : Wed, 11 Apr 2012
Answers:  2 Views:  604
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General & Family Physician 's  Response
Hi Nitesh,
Thanks for writing in.
The haemoglobin may not be rising above 15 in your case due to a deficiency of iron, vitamin B12 and folic acid. I would suggest you geta complete blood count ( with a peripheral smear), serum ferritin level and serum vitamin B12 level to uncover any such deficiency. If the levels are low, we can give you the appropriate supplements and you can have a normal haemoglobin.
Metformin and sitagliptin ( in Januvia) can negatively affect kidney function in some individuals and it could be a possible cause of nephropathy in your case.
As far as stabilization of the blood sugars is concerned, any acute infection can destabilize the sugars in the body and it is one thing that diabetics need to watch out for.
Hope this helps.
Answered: Wed, 11 Apr 2012
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Diabetologist Dr. Amit Rajput's  Response
Hello Nitesh,

As you went through hepatorenal failure (dysfunctioning of liver and kidneys), your nephropathy could just be the beginning of the disease . This seems a more likely cause of nephropathy. Doctors did right thing to put you on Insulin.

But one thing is proved that your body is susceptible for developing diabetes in future. You need to monitor your sugars on regular basis - preferably once every 15 days.

In the future if at all you develop diabetes, you can still be started upon oral tablets if your renal and hepatic functions are normal. Or maybe insulin, depending on the situation.

Wish you good health.

Answered: Wed, 11 Apr 2012
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