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Uncontrolled diabetes and hyperlipidemia - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Diabetes
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   Hello!
Doctor :   How can i help u ?
User :   Well this is about my father's medical condition so please bear with me
Doctor :   ok
User :   I have written everything down. His condition, illnessess, medications and lab results
Doctor :   ok
User :   this is going to be a long but necassary read for your sir...
Doctor :   ok
User :   66 year old male. 178 cm tall, weighs about 110 kg. Has been struggling with high blood pressure and gout for twenty years now. In 2009 his house doctor diagnosed him with Diabetes type 2, also has chronic kindney failure. As a young adult he kept himself active with sports like, fencing and cyckling. Was very slim and took great care of himself and body, but for the last ten years the pounds just kept piling up. He is unable to walk great distances when he has his gout attacks and becuase he has a minisc injury in his knee and also artrites. Has been to a hospital several times to extract fluid form his knee and was given steroid. At first his house doctor prescribed him pills for his Diabetes, Metformin 500mg 2x2 which didn't help at all. Now he goes to a Diabetic Specialist in November 2010 and was prescribed Victoza injection Liraglutid which he takes 12 units in the morning and another 12 units in the evening. Also, Lantus Solostar injection insulin glargin he takes 230 units now. His blood sugar levals on a emty stomach range from 7,8 to 15,6 . He has never been a morning person and skips breakfast and lunch. When he does eat its in the evening or late night and the portions of his meal(s) are for 2-3 persons. His medine List: Trombyl 75 mg blood thinners Spironolakton Nycomed 5 mg 1x1 against high blood pressure and blood clots Amlodipin Actavis 5 mg 1x1 against high blood pressure and blood clots Zyloric 300 mg against gout Lyrica 600 mg against anxiety and mood stabilator Lergigan Forte 50x3 mg against high anxiety stated Nov 2010 Victoza injections Diabetes 12 units in the morning and 12 units in the evening started Nov 2010 Lantus Solostar Diabetes takes 230 units today started taking them Nov 2010 Lab results B-Hb 132 134-170 g/L B-EPK 4.7 4.2-5.7 10E12/L B-EVF 0,41 0.39-0.50 0 (B)Ery-MCV 88 82-98 fL (B)Ery-MCH 28 27-33 pg (B)Ery-MCHC 320 317-357 g/L B-LPK 8.3 3,5-8.8 10E9/L B-TPK 156 145-348 10E9/L S-URAT 402 230-480 umol/L S-CK 1,7 0,70-4.7 ukat/L vS/P-Glukos 9.1 4.0-6.0 mmol/L fS-Triglycerider 5.1 0.45-2.6 mmol/L S-Kolesterol 4.0 3.9-7.8 mmol/L fS-HDL-Kolesterol 0.6 0.80-2.1 mmol/L S-Apolipoprotein A1 1.1 0.9-1.8 g/L S-Apolipoprottein B 1.0 0.6-1.6 g/L S-Apo B/Apo A1-kvot 0.9 0.4-1.2 0 S-Lipoprotein(a) 0.19 >0.30 g/L S-TSH 3.55 0.20-4.00 mE/L S-free T4 9 9-22 pmol/L B-HbA1c (IFCC) 86 31-46 mmol/mol (B)Erc-HbA1c 9.2 3.9-5.3 % S-ALAT 0.95 >1.2 ukat/L S-ALP 2.0 0.6-1.8 UKAT/L S-ASAT 0.61 >0.76 ukat/L S-CRP 20.6 >10.0 mg/L S-gamma-GT 3.49 3.6-5.0 umol/L S-KALIUM 3.8 3.6-5.0 MMOL/L S-Kreatinin 172 >100 umol/L S-NATRIUM 139 137-145 mmol/L
Doctor :   give me a few mintues to read the query
User :   ok
Doctor :   From what i see, you have included the referance levels along with the labs , is this right ?
User :   I believe so
Doctor :   the readings are very confusing , as they do overlap
User :   How do you mean, is the error on my part in how I've written them or do you mean the lab results are cinfusing in them selves?
Doctor :   let me go thru it any way
User :   please do
Doctor :   i will try to analyse it myself
User :   ok
Doctor :   based on these tests , your father has high sugar levels, high Trigylceride levels, low HDL levels,VERY high HBA1C AT 9.3 , high CRP, high s Creatinine
Doctor :   he needs better glucose controls
Doctor :   may i know what his blood pressure levels are ?
User :   Usually 140 over 90
User :   sometimes higher
User :   which levels are high, blood sugar and colesterol?
Doctor :   yes
User :   what do they mean?
Doctor :   they mean he has uncontrolled diabetes as well as hyperlipidemia (high cholesterol)
User :   His Diabetic Specialist has prescribed him Victoza and Lantus Solostar
Doctor :   from the history it seems that he does have eating issues
User :   he has nothing for colesterol
Doctor :   lack of proper diet habits will create havoc with diabetes control
User :   i mean no medication for coloerstorl
Doctor :   skiping breakfast and lunch is not a good idea .
Doctor :   that is fine
Doctor :   a medicine can be added at any time
User :   He has a specialist heart doctor and a Diabetic specialist. His heart is in very good shape inspite of his high blood pressure. there is no damage of the heart
User :   his diabetic specialist has given him injections
Doctor :   diabetes can be better controlled by lifestyle management and proper diet habit s
Doctor :   I do understand
User :   so what do you suggest
Doctor :   but those injections will work when he takes regular 2 large meals at lunch and dinner
User :   go on
User :   does he need stronger medication you mean
Doctor :   and 3 small eatings at break fast, at around 11 am and at around 5 pm
Doctor :   He does not need better medicines
Doctor :   he needs bettter self management
Doctor :   medicines can control only when he takes good control of his dietary patterns
User :   You are right and he know it too. We have diabetes in the family but as a artist he eat irregulary and still continues til today
Doctor :   when he misses his meals, and takes the medicine, the sugar may dip down, but as counter regulatory hormones come into play, the sugar then rises to higer levels
User :   His aware of the problem and is well read but its hard for him especially now coz he has lost his two brothers from Diabetes and his sister to lung cancer
Doctor :   also, since due to his age and then due to being overweight along with his gout this acts as a vicious cycle
User :   food has become a comfort for him. One brother was on dialysis and then had to amputate his legs
Doctor :   he is not able to lose weight by excercise due to gout
Doctor :   and he ten gains more weight due to being idle
Doctor :   this again worsens his gout and artritis and then inturn diabetes
Doctor :   I am sorry to hear that
User :   yes, thanks
User :   he has back pain because of his weight and knee injury
Doctor :   but it is difficult at this age, to change his habits as well
User :   but he has promised me to go and do rehabilation and special excercise
Doctor :   unless the idea of self improvement strikes to him, he will not be able to get out of this vicious cycle
Doctor :   the best way forward, is , ..
Doctor :   to take up rehab and excercise to try and lose some weight
User :   yes
Doctor :   If possible , surgery and bariatric surgery can be tried as well, to lose weight
Doctor :   this will depend on hid overall health and physical fitness
User :   he is scared of any kind of surgery so I'm almost positive that he wont take that action
User :   bariatric surgery is what exactly?
Doctor :   So in that case the process with rehab , excercise will help
Doctor :   here the absorption of food in the stomach is reduced by surgery
Doctor :   but this is a complicated surgery , and may not be applicable at his advanced age, and associated medical conditions
Doctor :   You can try, physiotherapy, and swimming excercises as well to help him lose weight
User :   physiotherapy is what is going to help him
User :   i will force and join him
Doctor :   yes, it will help him in moving his arms and become mobile
User :   but docotr, do you think the injection are good against the Diabetes he takes
Doctor :   and once he is mobile more, he will be able to lose the weight easily
Doctor :   the injections will work fine
Doctor :   but the issue is he takes the injection, and misses meals or does not take proper diabetic food
Doctor :   in that case , no medicines, however expensive, will not help him
User :   youre absolutely right
Doctor :   even a simple cost effective medicine, when taken along with proper diabetic diet, and exercises, will work wonders
User :   May I ask your opinion on another matter
User :   Its my twin sister. 33 year old female. Was diagnosed with Hep C and Cirrohis two years ago
Doctor :   he will have to follow a strict diabetic diet according to schdule, check his sugars 3-4 times a day and take all mediicines regularley
Doctor :   his will in the long run, will help him to control Diabetes effectively
User :   Takes Zoloft, Lergigan, Sobril
Doctor :   Yes sure , please proceed
Doctor :   ok
User :   Never done drugs, no tattoos, doesnt drink or even smoke. Was borne in Poland and then lived in the States we were 7 or 8 year old
User :   Is mentally and emotionally unstable in the sense of panic attacks and depression
User :   Is afraid to start treatment coz her psychiatrist warned her that there is a possibility that she will feel worse then now
User :   Is afaid of dying or developing cancer
User :   they did a bi-opsy. Her liver function is very good also her blood levals
Doctor :   may i know how she developed hepatitis C ?
User :   Has lost 50 kg in ten months
User :   Not sure how she developed
User :   since she is a virgin, doesnt smoke, does not take drugs, needles
Doctor :   ANY history of blood transfusions ?
User :   was diagnosed with it 2 years ago
User :   None
User :   She's mine twin and they tested me and I'm negative
User :   She is very, very agraid of death or developing cancer
Doctor :   so anyway, biopsy has proved she has hep C and now she has good LFTs
Doctor :   Is she married ?
User :   No
Doctor :   what is her occupation ?
Doctor :   what is her educational background ?
User :   studied journalism but since her depression and anxiety and panic attacks she is passive
User :   doesn nothing in other words
Doctor :   ok
Doctor :   a age of 33 , not working, and still not having a personal life are things that are hurting her
User :   was a straight A student, very ambitious and well read
Doctor :   may i know where u live ?
User :   Sweden
Doctor :   ok
Doctor :   She needs counselling and self help measures
Doctor :   pill popping for minor anziety is not the way of life
Doctor :   the mind is a very strong, if you let it be
User :   she has a psychiatrist and a doctor of gastronomy
User :   It is not minor, We had a very troubling childhood so there are mental and emotinal damages
User :   she was so anti-drug all her life but now she takes them in order to survive the day
User :   is a very bright, sensitive and good person. Sister, daughter etc
Doctor :   ok
User :   I understand what you mean.
Doctor :   the pills that she takes all just make the brain slow
Doctor :   she has to make the effort to get out of her mental blocks
Doctor :   the past cannot be changed
Doctor :   but the past should not hold the future to ransom
Doctor :   her past experiences seem to be holding her back
User :   that will take years. Its hard to face the naked truth when t comes to your parents. Its easier when a stranger, lover or even partner leaves or hurts you but if your parent(s) do that, its almost immpossible
Doctor :   may i know the exact cause of her issues ?
User :   She and I have always put our parents first and always did our best to be good daughters
User :   out mother is borderline and schizofrenic
Doctor :   As counselling and treatment will depend on the exact triggering factor
User :   well the factor is our childhood and partents
User :   what he have seen, felt, experinced and heard
User :   its pent up emotions from childhood that are still alive and breathing within us¨
User :   its easy to say, move away and be independent. forget your parents and live your life but our culture is different
Doctor :   well it is true, childhood is the factor that shapes up our adult life
User :   different.
Doctor :   any factor that affects the childhood can cause issues in the adult hood
User :   true
Doctor :   Anyway, so may i know the current issue with her ?
User :   I and my sister are very,very close. All our hurdles and problems we have gone through them together
User :   Im just afaid of losing her
User :   issue?
User :   its her hep C and cirrhsis
Doctor :   ok
User :   shes afraid of starting trearment in fear of feeling worse
User :   mentally and emotionally cause shes up and down
User :   very erratic
Doctor :   Usually chronic Hep C needs to be treated when the viral levels seem to be increased
Doctor :   and if the liver shows any changes
Doctor :   if the LFTs are normal and the liver biopsy is fine, there will not be any worsening issues with treatment
User :   The most recent test in 2010 were good
Doctor :   ok
User :   her liver function and blood levels
User :   they put a camera inside her and it all looked good
User :   no changes so far as I know
Doctor :   ok
Doctor :   that seems good
User :   yes
User :   but can she feel worse if she starts treatment
Doctor :   no
User :   mentally and emotionally
Doctor :   not at all
Doctor :   she will be fine
User :   how high or low are her chances of developing cancer?
User :   her god damn therapist scared the shxxxit out of her
User :   that she might be feeling worse
Doctor :   Hep C in case advances, to sever elvels can lead to cancer in 5 %
Doctor :   mind you , only in severe cases
User :   cause she is erratic and very, very sensative emotionally
Doctor :   but when the condition is stable, and all tests are normal, there is no need to worry about cancer
User :   thats very comforting to know
User :   she will be pleased to know that, as will I
User :   can her mood swings contribute to Hep C and cirrhosis?
User :   is there a link between them?
Doctor :   no they will not affect them
User :   i see.
Doctor :   they are not related in any manner
User :   ok
User :   hormones
User :   thyroid you think
Doctor :   mood swwings could be related to her depression and panic attacks
User :   yes.
Doctor :   she need a good counsellor who can increase her confidence
User :   she is very confident in herself earlier
User :   she knew her worth
User :   very sure of herself, maybe too much "laughing"
Doctor :   ok
User :   thank you for your time and advice doctor. Have a great day or night.
Doctor :   you are welcome
User :   bye
Doctor :   please leave your feed back
Doctor :   it will be appreciated
User :   sure
Doctor :   take care and bye for now
User :   bye
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