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How to keep blood sugar level under control?

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Posted on Mon, 14 Jul 2014
Question: HELLO DOC

my mother's sugar level after taking lunch always remains above 250 mg/dl.sugar level for fasting,pp(breakfast) and pp(dinner) r below 200 mg/dl.iam worried that how should i make her sugar level after taking lunch below 250 mg/dl. here r some previous HBA1C readings for better understanding.

12 febuary 2014- 5.5%

15 XXXXXXX 2014- 5.4%
doctor
Answered by Dr. M. Vamsi Krishna (24 minutes later)
Brief Answer:
diet plan is very important in diabetes

Detailed Answer:
Dear Sir i can understand your concern.
i am very happy to see your mother's previous Hba1c are in very good control and she is doing very well.
i am having few questions
1.what are medication taken by her for diabetes.
2.what is duration of Diabetes.
3.height and weight
4.any h/o of bleeding like hemorrhoids and peptic ulcer
5.is she facing any low sugars if so how many and when.

Usually lunch will be big meal of the day.By careful adjusting the composition of lunch after food blood sugars can be controlled
pls provide me required information for further analysis.
I am ready for further discussion

Dr XXXXXXX XXXXXXX
Diabetologist
Apollo Hospitals
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. M. Vamsi Krishna (31 minutes later)
-medication=amaryl 1,thyronorm,pantop dsr,matilda forte,shelcal m,volix m,razel,orofer xt.

-duration=approx 7 to 8 years

-weight= approx 50 kg,height=166 cm

-no bleeding like hemorrhoids and peptic ulcer

-yes there has been situation where she had low sugar after which i gave 2 spoon of sugars.but this is not frequent.what i can recall is for past 6 months low sugar was their for 3 times and generally it used to happen in fasting and pp(breakfast).

one more thing since my mothers hba1c readings r quite good what then what happens to the indivudual readings.should i take hba1c or gulcosemeter reading seriously.
doctor
Answered by Dr. M. Vamsi Krishna (38 minutes later)
Brief Answer:
need diet modification....

Detailed Answer:
Thank you for providing info in such a short notice.

At the outset, I am very happy to see her metabolic profile is very good. Further it is heartening to know there are no frequent hypoglycemia's. In this instance, I feel the current list of medicines aer fine. She needs to follow a good diet regimen to lower sugar values further. Try talking to a nutritionist for a diet plan.

Both Hba1c and individual readings are important.
Especially people who are having medical condition like low haemoglobin we can not depend only on HBa1c, as in anaemia the Hba1c is not reliable.

Individual sugar estimation should be done twice weekly on lunch dinner and breakfast in uncontrolled patients and once weekly in well controlled patients.
Once in a month check sugars at early morning 3 am as its the time where patient might have lowest sugar of the day.

Once in 6 months glucometer should be Calibrated.

In short, in my opinion her medical treatment is good. She needs to work on her diet. Discuss with a nutritionist and plan a good dietary regimen.

Regards
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. M. Vamsi Krishna (1 hour later)
HELLO DOC
I HAVE UPLOADED MY MOTHER'S MEDICAL REPORTS THIS MIGHT GIVE U A BETTER IDEA.THE REPORT IS RECENT ONE AND A BIT LONG.U MENTIONED ANAEMIA AND HEMOGLOBIN IN UR REPLY SO I THOUGHT IT WILL BE BETTER.
doctor
Answered by Dr. M. Vamsi Krishna (54 minutes later)
Brief Answer:
iron deficency anaemia

Detailed Answer:
Dear sir after careful analysis of your moms reports there are few points which I want to highlight.
haemoglobin levels are borderline low---11.1 along with this there is low mch and mchc which is showing that there might be iron deficiency anaemia.
The TSH is also elevated --14.4
The uncontrolled thyroid might be one of the reason for anaemia.
In uncontrolled thyroid there will be defective iron absorption so in such cases oral iron might not be effective.
Correcting thyroid is very important.
in this kind of scenario we need to depend on individual glucose estimation.
i suggest you to prepare a chart with seven point glucose estimation
the seven points are
1.Fasting
2.2 hrs after breakfast
3.before lunch
4.2 hrs after lunch
5.before dinner
6.2 hrs after dinner
7.At early morning 3 am
This can be done once in a week and treatment can be adjusted basing on this values.
There is latest technology available called CGMS (continuous glucose monitoring system)which will do 600 blood sugar test per day without any pain.This small chip can be used for 7 days and give a good graph of sugar levels.
Regards
Dr XXXXXXX XXXXXXX
Diabetologist
Apollo Hospitals
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. M. Vamsi Krishna (38 minutes later)
-thyroditis was detected just a month ago so do u think that going forward the iron deficiency will become good for which the doctor has already started thyronorn and razel medicine.
-which medicine has doctor given for iron deficiency .
-where can i buy cgms and approx cost .i live in XXXXXXX
doctor
Answered by Dr. M. Vamsi Krishna (1 hour later)
Brief Answer:
Cgms

Detailed Answer:
Dear XXXXXXX
orofer xt is the medication give for mom to improve iron.
with the recovery of thyroid...anaemia will also recover.
CGMS is marketed by company called meditronics
no need to buy the machine
The device is called ipro-2 device
you need to buy sensor the cost of sensor will be aprox 6000 inr
i suggest you find the medical representative for meditronics and he will come to your home and fix the device to your mother its a very small chip kind of device and absolutely there will be no difficulty in wearing it.

Address of medtronic in XXXXXXX
New XXXXXXX
A-16, Ground Floor XXXXXXX Cooperative Industrial Area XXXXXXX Road
New Delhi-110044 XXXXXXX
Phone: +91-11-0000/21/22/23
Fax: +91-11-0000

Kindly write to me for any further questions in Diabetes.
Regards
Dr XXXXXXX
Diabetologist
Apollo Hospitals

Above answer was peer-reviewed by : Dr. Prasad
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Dr. M. Vamsi Krishna

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How to keep blood sugar level under control?

Brief Answer: diet plan is very important in diabetes Detailed Answer: Dear Sir i can understand your concern. i am very happy to see your mother's previous Hba1c are in very good control and she is doing very well. i am having few questions 1.what are medication taken by her for diabetes. 2.what is duration of Diabetes. 3.height and weight 4.any h/o of bleeding like hemorrhoids and peptic ulcer 5.is she facing any low sugars if so how many and when. Usually lunch will be big meal of the day.By careful adjusting the composition of lunch after food blood sugars can be controlled pls provide me required information for further analysis. I am ready for further discussion Dr XXXXXXX XXXXXXX Diabetologist Apollo Hospitals