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Is HbA1C Level Of 8 A Cause For Concern?
Question: I am a diabetic person of 63 years retired from a MNC. I have a problem of feet numbness. my feet are not able to sense vibrations & my sleep is badly affected.
I take nuhenz tablet in the morning & pragabalin generic after dinner but still suffer sleep.
My HbA1C is 8. I also have thyroid & take Altroxin 100.
I need advise from neurophysician.
I take nuhenz tablet in the morning & pragabalin generic after dinner but still suffer sleep.
My HbA1C is 8. I also have thyroid & take Altroxin 100.
I need advise from neurophysician.
Brief Answer:
You need to get several metabolic labs performed
Detailed Answer:
Good evening.
Thank you for your question. Your dilemma is common among diabetics and I will tell you my basic approach to working toward improving my patients' overall quality of life when it comes to their condition of diabetic polyneuropathy.
Here's is the most obvious and BASIC recommendation I can give you regarding your condition. You absolutely should focus and streamline your efforts, financial resources, and attention both medically and otherwise toward one thing in order to make the BIGGEST difference to your symptoms that you describe. Get your DIABETES MELLITUS under much better control. A HbA1C of 7 will be better than 8 and an A1C of 6.5 even better than 7.
I am very diligent about emphasizing to my patients that everything we do to investigate reasons why numbness/tingling/pain/loss of vibratory sense, etc. etc. is but a small percentage of all the cases of neuropathy that are out there as a consequence of diabetes. So while the workup is still possible to do for thyroids, Vit. B12, and all the rest that I will you about in a moment....nothing can beat CONTROL OF THE DIABETES.....and CONTROL of diabetes involves DIET, EXERCISE, COMPLIANCE with medications, SMOKING CESSATION, ALCOHOL CESSATION, and regular doctor followups (no matter how well a patient thinks they may be doing).
The laboratory workup for neuropathy in these situations should always include a thyroid set of tests which I always get as TSH and FT4 as well as Vit.B12, Folate, Vit. D, ANA, and Total and Free TESTOSTERONE when dealing with males. B12 levels nowadays should be closer to 400 while Vit. D levels in my practice for patients with neurological deficits is always targetted for 60-80.
Pregabalin is typically a reasonable drug for neuropathic symptoms but don't forget about some of the more basic and time tested ones such as gabapentin, nortriptyline, and Alpha Lipoic Acid (ALA) which is over the counter but my patients have found consistently helpful for at least mild to moderate cases of neuropathy. Then, there are things such as CAPSAICIN cream applied to the feet and ankles which works well but is unfortunately uncomfortable at the outset and has a relatively short duration of action. However, it can be very effective for the few hours that it does work so that it may make sense to use it at nighttime.
If I were in your position I would ask the doctor to consider the above workup I've suggested and then, if all those parameters were negative AND you as the patient have really made a true blue effort at controlling your diabetes as I outlined you should with diet, exercise, and smoking cessation then, on the medication end I would recommend escalating the pregabalin dose to see if that could help before changing to another medication or medications entirely.
And my motto by the way when starting anybody on medications that are new or potentially capable of affecting the central nervous system to cause brain fog or other nervous system complicatons is "START LOW and GO SLOW!" This means a LOW amount of medication to start with and a very slow upward titration to either clinical effects or side effects.
If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 35 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
You need to get several metabolic labs performed
Detailed Answer:
Good evening.
Thank you for your question. Your dilemma is common among diabetics and I will tell you my basic approach to working toward improving my patients' overall quality of life when it comes to their condition of diabetic polyneuropathy.
Here's is the most obvious and BASIC recommendation I can give you regarding your condition. You absolutely should focus and streamline your efforts, financial resources, and attention both medically and otherwise toward one thing in order to make the BIGGEST difference to your symptoms that you describe. Get your DIABETES MELLITUS under much better control. A HbA1C of 7 will be better than 8 and an A1C of 6.5 even better than 7.
I am very diligent about emphasizing to my patients that everything we do to investigate reasons why numbness/tingling/pain/loss of vibratory sense, etc. etc. is but a small percentage of all the cases of neuropathy that are out there as a consequence of diabetes. So while the workup is still possible to do for thyroids, Vit. B12, and all the rest that I will you about in a moment....nothing can beat CONTROL OF THE DIABETES.....and CONTROL of diabetes involves DIET, EXERCISE, COMPLIANCE with medications, SMOKING CESSATION, ALCOHOL CESSATION, and regular doctor followups (no matter how well a patient thinks they may be doing).
The laboratory workup for neuropathy in these situations should always include a thyroid set of tests which I always get as TSH and FT4 as well as Vit.B12, Folate, Vit. D, ANA, and Total and Free TESTOSTERONE when dealing with males. B12 levels nowadays should be closer to 400 while Vit. D levels in my practice for patients with neurological deficits is always targetted for 60-80.
Pregabalin is typically a reasonable drug for neuropathic symptoms but don't forget about some of the more basic and time tested ones such as gabapentin, nortriptyline, and Alpha Lipoic Acid (ALA) which is over the counter but my patients have found consistently helpful for at least mild to moderate cases of neuropathy. Then, there are things such as CAPSAICIN cream applied to the feet and ankles which works well but is unfortunately uncomfortable at the outset and has a relatively short duration of action. However, it can be very effective for the few hours that it does work so that it may make sense to use it at nighttime.
If I were in your position I would ask the doctor to consider the above workup I've suggested and then, if all those parameters were negative AND you as the patient have really made a true blue effort at controlling your diabetes as I outlined you should with diet, exercise, and smoking cessation then, on the medication end I would recommend escalating the pregabalin dose to see if that could help before changing to another medication or medications entirely.
And my motto by the way when starting anybody on medications that are new or potentially capable of affecting the central nervous system to cause brain fog or other nervous system complicatons is "START LOW and GO SLOW!" This means a LOW amount of medication to start with and a very slow upward titration to either clinical effects or side effects.
If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 35 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks Doctor for taking time to answer my chronic complaint. I request you to let me know the exact medication I should try over & above bringing down my HBA1C to 6.5. I have started walking for 45 minutes since last 2 days which I fid not do despite my doctor's advise. I am stressed because of this & request you to prescribe cream or tablets as you feel fit. As mentioned by you if pragabalin dose is to be increased or any different medication is to be tried, pl let me know soecifically. I suffer even in afternoon when I sleep.
Brief Answer:
Primary Course of Action should be to Control Diabetes Maximally
Detailed Answer:
Thank you for your return question.
Once again, I'm hopeful that my message is being clearly understood regarding the need to CONTROL THE DIABETIC CONDITION itself to its maximum potential as opposed to trying to find medications to combat its consequences. I'm not sure that message was clearly understood by way of your return response. I did read the very encouraging statement you made about walking in the past 2 days but I am talking about managing changes to lifestyle more profound that would include DIET (specific to each person's needs but in general the idea is reduce carbohydrates and increase protein intake), EXERCISE (in addition to walking), WEIGHT LOSS (preferably under supervision of a nutritionist) so that the ideal bodyweight can be achieved which will greatly enhance the body's ability to utilize and metabolize glucose properly, CONTROL OF HYPERTENSION, SMOKING AND ALCOHOL REDUCTION or even cessation as these 2 items are very offensive to diabetic conditions.
If it is true that the patient has done everything possible in those categories of lifestyle changes for a period of at least 14-16 weeks then, changes in the A1C and feelings of general well being and many other problems consequent to the diabetes which have been bothering the patient will show dramatic improvement and will likely not require the use of medications as much or even at all. However, the use of medication is indicated in certain types of symptoms such as neuropathy or diabetic ulcers, etc. to bring certain conditions under better control due to necessity or comfort. But I want to be sure patients understand that the PRIMARY and most EFFECTIVE treatments for diabetes and its consequences are the major lifestyle changes which cannot occur on the basis of medications but rather come from daily habits and routines that must be modified.e individual.
As far as prescribing medications is considered we are unable to perform prescriptions on this network. We can only give the best advice possible to patients since there are limitations such as not being able to examine or see patients physically. Therefore, it becomes the responsibility of the treating physician to actually give patients presriptions which may or may not be in line with recommendations given here. I hope you understand this aspect of Healthcaremagic as a service. Also, it is not possible to give specific dosage instructions for the same reason of not knowing the patients well enough nor can we presuppose what other medications or conditions a patient may have that would interfere or be made worse by certain medications recommended and accompanying doses.
If you will refer back to the original response I've given you regarding the specific reference to medications used to treat neuropathy I mentioned several that are commonly used with success in many of my patients. They are:
1. Gabapentin
2. Nortriptyline
3. Pregabalin
4. Alpha Lipoic Acid
5. Capsaicin Cream
In your case you are already on pregabalin and therefore, I recommended in my previous answer that you discuss with the doctor treating you the wisdom of potentially raising the dose of what you're taking slowly to see if you can receive any more benefit to your symptoms. However, the caution is that the medication not be increased if you have not made the PRIMARY CHANGES to lifestyle stated above because in that regard you may very well taking a substance into your body that you really do not need or at least don't need as much of....therefore, the idea is to avoid toxicity unnecessarily.
As far as the other medications are concerned it is the exact same argument. You should discuss these with your doctor so that the BEST STARTING DOSE can be chosen and followed then, raised SLOWLY to test for therapeutic effects to avoid toxicity issues.
Nortriptyline must be taken carefully in males and titrated very slowly (usually no greater than 10 mg. weekly) but is clearly contraindicated if patients have prostate gland problems, problems with what is referred to as orthostatic blood pressure (getting dizzy when getting up and walking), or suffer from insomnia.
Alpha Lipoic acid is an over the counter medication here in the U.S.A. and many of my patients will find reductions in their blood sugars, improvement in neuropathy, and improvement in the A1C but again the dose is variable and should only be managed by the treating physician in light of many other parameters only known to the doctor.
Capsaicin cream can be obtained over the counter and directions followed to rub on affected areas of neuropathic pain such as feet, legs, and hands (if involved). There is a caution that one should only use the smallest amount to start with since there is a burning sensation that many people react to right away. It goes away after about 30-60 seconds as the medicine starts settling in but will take you by XXXXXXX if you're not expecting it to happen. It is generally my practice to have patients use this mainly at nighttime to help them get to sleep and perhaps wake up just once for a reapplication and sometimes not even that if the patient can stay asleep.
As far as medications for the diabetes itself there are many choices and I am not quite as well versed in those drugs since they are changing rapidly. I am most familiar with primary antidiabetic drugs such as metformin, glipizide, and of course, INSULIN which is generally given in different injectable forms. Your primary doctor will know which form is best for you and whether you should taking such injections on a regimented schedule or apply them only when your sugars are above a certain level. This is referred to using insulin on a SLIDING SCALE.
Once again the hope is that the information presented can be used to help you and your doctor discuss options of therapy and that you will highly consider the very important and relevant topic of important and impactful lifestyle changes needed to fight diabetes more so than medication.
Could you do me the favor of CLOSING THE QUERY and include some fine words of support along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.
This query has utilized a total of 80 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Primary Course of Action should be to Control Diabetes Maximally
Detailed Answer:
Thank you for your return question.
Once again, I'm hopeful that my message is being clearly understood regarding the need to CONTROL THE DIABETIC CONDITION itself to its maximum potential as opposed to trying to find medications to combat its consequences. I'm not sure that message was clearly understood by way of your return response. I did read the very encouraging statement you made about walking in the past 2 days but I am talking about managing changes to lifestyle more profound that would include DIET (specific to each person's needs but in general the idea is reduce carbohydrates and increase protein intake), EXERCISE (in addition to walking), WEIGHT LOSS (preferably under supervision of a nutritionist) so that the ideal bodyweight can be achieved which will greatly enhance the body's ability to utilize and metabolize glucose properly, CONTROL OF HYPERTENSION, SMOKING AND ALCOHOL REDUCTION or even cessation as these 2 items are very offensive to diabetic conditions.
If it is true that the patient has done everything possible in those categories of lifestyle changes for a period of at least 14-16 weeks then, changes in the A1C and feelings of general well being and many other problems consequent to the diabetes which have been bothering the patient will show dramatic improvement and will likely not require the use of medications as much or even at all. However, the use of medication is indicated in certain types of symptoms such as neuropathy or diabetic ulcers, etc. to bring certain conditions under better control due to necessity or comfort. But I want to be sure patients understand that the PRIMARY and most EFFECTIVE treatments for diabetes and its consequences are the major lifestyle changes which cannot occur on the basis of medications but rather come from daily habits and routines that must be modified.e individual.
As far as prescribing medications is considered we are unable to perform prescriptions on this network. We can only give the best advice possible to patients since there are limitations such as not being able to examine or see patients physically. Therefore, it becomes the responsibility of the treating physician to actually give patients presriptions which may or may not be in line with recommendations given here. I hope you understand this aspect of Healthcaremagic as a service. Also, it is not possible to give specific dosage instructions for the same reason of not knowing the patients well enough nor can we presuppose what other medications or conditions a patient may have that would interfere or be made worse by certain medications recommended and accompanying doses.
If you will refer back to the original response I've given you regarding the specific reference to medications used to treat neuropathy I mentioned several that are commonly used with success in many of my patients. They are:
1. Gabapentin
2. Nortriptyline
3. Pregabalin
4. Alpha Lipoic Acid
5. Capsaicin Cream
In your case you are already on pregabalin and therefore, I recommended in my previous answer that you discuss with the doctor treating you the wisdom of potentially raising the dose of what you're taking slowly to see if you can receive any more benefit to your symptoms. However, the caution is that the medication not be increased if you have not made the PRIMARY CHANGES to lifestyle stated above because in that regard you may very well taking a substance into your body that you really do not need or at least don't need as much of....therefore, the idea is to avoid toxicity unnecessarily.
As far as the other medications are concerned it is the exact same argument. You should discuss these with your doctor so that the BEST STARTING DOSE can be chosen and followed then, raised SLOWLY to test for therapeutic effects to avoid toxicity issues.
Nortriptyline must be taken carefully in males and titrated very slowly (usually no greater than 10 mg. weekly) but is clearly contraindicated if patients have prostate gland problems, problems with what is referred to as orthostatic blood pressure (getting dizzy when getting up and walking), or suffer from insomnia.
Alpha Lipoic acid is an over the counter medication here in the U.S.A. and many of my patients will find reductions in their blood sugars, improvement in neuropathy, and improvement in the A1C but again the dose is variable and should only be managed by the treating physician in light of many other parameters only known to the doctor.
Capsaicin cream can be obtained over the counter and directions followed to rub on affected areas of neuropathic pain such as feet, legs, and hands (if involved). There is a caution that one should only use the smallest amount to start with since there is a burning sensation that many people react to right away. It goes away after about 30-60 seconds as the medicine starts settling in but will take you by XXXXXXX if you're not expecting it to happen. It is generally my practice to have patients use this mainly at nighttime to help them get to sleep and perhaps wake up just once for a reapplication and sometimes not even that if the patient can stay asleep.
As far as medications for the diabetes itself there are many choices and I am not quite as well versed in those drugs since they are changing rapidly. I am most familiar with primary antidiabetic drugs such as metformin, glipizide, and of course, INSULIN which is generally given in different injectable forms. Your primary doctor will know which form is best for you and whether you should taking such injections on a regimented schedule or apply them only when your sugars are above a certain level. This is referred to using insulin on a SLIDING SCALE.
Once again the hope is that the information presented can be used to help you and your doctor discuss options of therapy and that you will highly consider the very important and relevant topic of important and impactful lifestyle changes needed to fight diabetes more so than medication.
Could you do me the favor of CLOSING THE QUERY and include some fine words of support along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.
This query has utilized a total of 80 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks doctor for your prompt response. I checked on 1Mg app & found few names on capsaicin based ointments. These are capsaicin based rubifaciants plusdiclophenic topical plusgabapentin topical. Another is capsaicin based rubifacients plus gavapentin topical plus ketoprofen topical & third is capsaicin based rubefacients. under each of above, there few names of medicines/ creams/ ointments which is quite confusing. can you pl advise a particular name?
As far as diabetes is concerned, me & my diabetologist are working hard to get HbA1C to 6.5.
I would be happy if you can advise exact medicines so that I can fix with my diabetologist as I need a good sleep.
My problem is only with my feet bottom.
I do not take tobacco or alcohol.
Kindly advise.
As far as diabetes is concerned, me & my diabetologist are working hard to get HbA1C to 6.5.
I would be happy if you can advise exact medicines so that I can fix with my diabetologist as I need a good sleep.
My problem is only with my feet bottom.
I do not take tobacco or alcohol.
Kindly advise.
Brief Answer:
Any cream with capsaicin is quite satisfactory
Detailed Answer:
Good morning and thank you for your response. Any type of cream that contains capsaicin is quite satisfactory. What's added as a secondary is of little consequence to the efficacy of the capsaicin.
It is quite commendable that you do not smoke or drink alcohol. That's a huge advantage when it comes to getting ahead of any neuropathy causing your discomfort.
If you have a diabetologist then, I guarantee that he/she has more names in mind for medications you can use to control your diabetes since those regularly change. As a neurologist, please review the list of several medications that I named for you in both previous messages and use them as the starting point to investigate possible agents for the neuropathic pains in your feet.
My recommendation which you can discuss with your diabetologist or neurologist is that no matter which medication you choose that you start at the lowest possible doses and slowly uptitrate to the point where clinical improvement occurs. This will guarantee that you will only be using the amount of medication you need to treat symptoms which is always an advantage when it comes to extending the lifespan of any drug for neuropathic pain since unfortunately, often times clinical efficacy can wane over time requiring escalations of doses.
Could you do me the favor of CLOSING THE QUERY and include some fine words of support along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.
This query has utilized a total of 100 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Any cream with capsaicin is quite satisfactory
Detailed Answer:
Good morning and thank you for your response. Any type of cream that contains capsaicin is quite satisfactory. What's added as a secondary is of little consequence to the efficacy of the capsaicin.
It is quite commendable that you do not smoke or drink alcohol. That's a huge advantage when it comes to getting ahead of any neuropathy causing your discomfort.
If you have a diabetologist then, I guarantee that he/she has more names in mind for medications you can use to control your diabetes since those regularly change. As a neurologist, please review the list of several medications that I named for you in both previous messages and use them as the starting point to investigate possible agents for the neuropathic pains in your feet.
My recommendation which you can discuss with your diabetologist or neurologist is that no matter which medication you choose that you start at the lowest possible doses and slowly uptitrate to the point where clinical improvement occurs. This will guarantee that you will only be using the amount of medication you need to treat symptoms which is always an advantage when it comes to extending the lifespan of any drug for neuropathic pain since unfortunately, often times clinical efficacy can wane over time requiring escalations of doses.
Could you do me the favor of CLOSING THE QUERY and include some fine words of support along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.
This query has utilized a total of 100 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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