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Dr. Andrew Rynne

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Alcoholic. Diagnosed with high cholesterol. Lipid profile test done. Am I at risk of diabetes?

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Dr. Om Lakhani

Endocrinologist

Practicing since :2004

Answered : 319 Questions

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Posted on Fri, 8 Feb 2013 in Smoking and Alcohol Addiction
Question: I have been a heavy alcohol user for the last 6 months. I have been recently diagnosed with high cholesterol.
The lipid profile test readings were:
Cholestrol Serum - 248.00 mg/dL
Triglycerides - 227 mg/dL
LDL - 163.6 mg/dL
HDL - 39 mg/dL
Total Cholestrol/HDL ratio 6.3
VLDL Cholestrol 45.4 mg/dL
I visited a cardiologist who advised other tests like Carotid Doppler, Hba1c, TSH, Vitamin D, RPI, LFT, urine microalbumin, cardiac stress test and abdomen utlrasound. The results are as follows:
Carotid Doppler: Normal
Abdomen Ultrasound: Normal, except for fat deposits on the liver.
TSH: Within normal ranges
Vitamin D level: Low 20.4 ng/mL
Urine Microalbumin: Normal
Renal Package: Normal except slightly higher Uric acid 6.9 mg/dL
Cardiac Stress Test: HR: 163 bpm Reached 84% of XXXXXXX predicted 194bpm XXXXXXX BP: 150/90
Liver Function Test: High SGPT (130) high SGOT(53) high GGTP (77) high Bilirubin (0.9 mg/dL), other parameters are normal
HBa1c: 6.4
No Glucose, Blood, Ketone, Bile in Urine.

I have started on a low fat diet and on an exercise routine. Do you think I have diabetes based on the above information or is the high hba1c just a manifestation of high cholesterol. I am hypertensive and I have a family history of hypertension. However, there is no history of diabetes in my family. As I have mentioned before I was a heavy user of alcohol for the past 6 months.
i forgot to mention. I have no diabetes related common symptoms. I have gained about 9 kgs in the last 1 year.
doctor
Answered by Dr. Om Lakhani 4 hours later
Hi XXXXXXX

Here is my interpretation of your reports

1. The total cholesterol and especially your LDL is high. We need to bring it down. I would advice you to take anti-cholesterol medications. The lower the better but alteast LDL <100 is advisable in your case

2. Your HbA1c is in Prediabetic range. Range of 5.7-6.5 % is prediabetic. No it is not high because of your high cholesterol but it is simply high . It is not in diabetic range as yet but very close to it.

3. You LFT are also not so good. SGPT and SGPOT are high which suggest an ongoing liver inflammation. With your alcohol use and your fatty liver it is expected.

You are suffering from what is known as "Metabolic syndrome". This is a typical constellation of conditions consisting of obesity, high cholesterol, Diabetic/prediatetic state and hypertension. You fulfill all the criteria for metabolic syndrome. At age of 26 yrs only , it is not a good sign. High liver enzymes are also now recognized to be a part of this syndrome

Here is what we will do:

1. Quit alcohol . There is no other way. You have already started developing liver inflammation. This is not a good sign and if you continue to drink it will only get worse.
2. Exercise. You need atleast 30 min of good quality exercise for alteast 5 times a week REGULARLY. If you can loose about 10% of you weight in 3-6 months , many of your problems will be solved . We can get you HbA1c down by 1 point by loosing 10% of your weight.
3. Take Vitamin D supplements. There are sachets available for this. Take 1 XXXXXXX a week for 4 week then once a month. Low Vitamin D contributes to some extent to poor cholesterol control and metabolic syndrome .
4. DIET. Get a good dietitian to prepare a diet plan for you. Low in carbs, low in fat , high in fibres and protein with calorie restriction.

We will continue with this plan for 3 months. You can get done your HbA1c again after 3 months. If it is still in the diabetic range , I would advice you to start medications for that too. Now we have medications which can be taken by pre-diabetics to avoid development of full blown diabetes, but before starting those I would recommend a trial of lifestyle measures.

Regards
Dr. Om Lakhani, MD
Consultant Diabetologist
WWW.WWWW.WW (online expert diabetes care consultantion)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Om Lakhani 50 minutes later
I didn't mention earlier but I have been on some anti-anxiety medicines (Stalopam 10 mg for the first 3 months and Stalopam 5 mg since) for the past one year. These were prescribed to me do to anxiety and panic attacks. I however, feel fine now and my a visit to the psychiatrist again is long due. Do you think these anti anxiety pills have a contribution apart from other factors towards my current health.
doctor
Answered by Dr. Om Lakhani 2 hours later
Hi XXXXXXX

Yes these medications cause a weight gain but no significant effect in other things.

You can discuss with your psychiatrist whether you should continue this or not.

Regards
Dr. Om .
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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