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Suggest Remedy For Acid Reflux And Diabetes
Question: DIABETOLOGIST: I'm a retired E.R.-R.N. with a 38 y.o. son diagnosed with Diabetes type II 6 yrs ago, he lives & works alone in a small town W. XXXXXXX Island. I could sense that his sugar was up in XXXXXXX & pleaded he check his level for "Mama". He's usually quite stable, but was in a new relationship & pretending he was healthy for several mos.....B.S. 32!!!! ER admitted him with an Internist consult, insulin, & sent him home next day, under care of Family Practitioner. It took 3 mos to get his sugar stabilized at 6, meanwhile his body is falling apart & I've contacted his family Dr. & expressed my concerns, including a request for an Endocrinologist consult, to no avail. I'm guessing that his G.P. doesn't know what he doesn't know! His biggest concern seems to be whether XXXXXXX can "still get-it-up' & here's some "Viagra!!"
My young man has been otherwise healthy, weighs 170 & is 6'1"........I know he needs a strong advocate & I may have to fly there to get him the care he needs, but I live with my nurse daughter & provide care for my young granddaughter everyday, so it's difficult.
Steve's signs & symptoms:
1) On Glyciside, Long acting Insulin 30u., after Humulin 4 u. /c meals he has severe reactions of >2. Also has scarey night time reactions with disorientation. Uses Sugar pills.
2) severe neuropathy pain/sensitivity/phlebitis/burning both legs & arms, but especially lower legs/feet. Also pain & weakness above Kidneys to shoulders
3)gastric/bowel distress.....acid reflux, delayed emptying of stomach,bloating, gut ache, inadequate stools
Gavapentin 400mg ineffective
4) moderate impotence & clear, serous ejaculate.
5) reactional depression (feels like his episode of denial has screwed-himself-up forever & his life is over.
Emotional irritability. (Dr. offered anti-depressants, but XXXXXXX refuses to go there!)
Sorry this is so complicated, but would you please guide me. Thank you from the bottom of my Soul! XXXXXXX Cranston (worried Mom)
YYYY@YYYY
My young man has been otherwise healthy, weighs 170 & is 6'1"........I know he needs a strong advocate & I may have to fly there to get him the care he needs, but I live with my nurse daughter & provide care for my young granddaughter everyday, so it's difficult.
Steve's signs & symptoms:
1) On Glyciside, Long acting Insulin 30u., after Humulin 4 u. /c meals he has severe reactions of >2. Also has scarey night time reactions with disorientation. Uses Sugar pills.
2) severe neuropathy pain/sensitivity/phlebitis/burning both legs & arms, but especially lower legs/feet. Also pain & weakness above Kidneys to shoulders
3)gastric/bowel distress.....acid reflux, delayed emptying of stomach,bloating, gut ache, inadequate stools
Gavapentin 400mg ineffective
4) moderate impotence & clear, serous ejaculate.
5) reactional depression (feels like his episode of denial has screwed-himself-up forever & his life is over.
Emotional irritability. (Dr. offered anti-depressants, but XXXXXXX refuses to go there!)
Sorry this is so complicated, but would you please guide me. Thank you from the bottom of my Soul! XXXXXXX Cranston (worried Mom)
YYYY@YYYY
Brief Answer:
An assement of his symptoms
Detailed Answer:
Good day,
Noted your concerns.
From the symptoms you provides, he seems to have Type 2 Diabetes Mellitus with following complicatios
a) Peripheral neuropathy with ? Autonomic neuropathy ( in view of erection problems)
b) Gastroparesis ( as XXXXXXX of neuropathy)
c)Impotence
d)Depression
f) Hypoglcemias
In an ideal setting, he need a cmprehensive assessment of all the diabetes associated problems. But i do understand the limitations of a small town. His GP may not be able to handle such complex problems.
a) He needs to be evaluated for eye problems ( a dialated eye examinatiom to look for retinopathy
b) A through check up for identifying kidney dysfunction and to detect if there is protein leak in urine,
c) Blood pressure assesmment and to keep his BP below 130/80 mm hg , safely
d) Check Cholsterol profile
e) Feet assessment for neuropathy and blood supply
f) Thyroid functions and Prolactin in view of erectile dysfunction.
g) HbA1c
He need Metformin/Januvia combination. This will help to reduce his weight as well. ( however, in view of stomach problems, he may not be able to handle them well. Besides, kidney has to be assessed before starting these medicines)
He need to continue basal bolus insulin. However, in view of nocturnal hypoglycemias. it is better to start on Lantus insulin instead of the current long acting insulin.And I would change his Humulin-R to more short acting Novorapid insulin. That will prevent Hypoglycemia.
Depression and Anxiety could be adding to his bad sugar control and he may benefit from a combination of drugs, counselling, yoga etc. ( i know he hates drugs, but a counselling session may change hs attitude).
Erection problems may be adding to his mental worries. That worry itself worsens sugar control.
HAev you got a cance to look at his recent kidney function tests??
You have to convince him to come over to city to meet an endocrinologist. If not possible, you may change him to a basal bolus insuliin along wth Januvia and Metformin ( if no contraindications).
I know, it is a lengthy list. But diabetes need a comprehensive approach. He is young and unfortunately, has multiple complications. We need to look after the complications and need to prevet new complications. This is possible only with a good blood glucose control along wih Blood pressure and cholsterol control.
Pease feel free to discuss further
Regards
Binu
An assement of his symptoms
Detailed Answer:
Good day,
Noted your concerns.
From the symptoms you provides, he seems to have Type 2 Diabetes Mellitus with following complicatios
a) Peripheral neuropathy with ? Autonomic neuropathy ( in view of erection problems)
b) Gastroparesis ( as XXXXXXX of neuropathy)
c)Impotence
d)Depression
f) Hypoglcemias
In an ideal setting, he need a cmprehensive assessment of all the diabetes associated problems. But i do understand the limitations of a small town. His GP may not be able to handle such complex problems.
a) He needs to be evaluated for eye problems ( a dialated eye examinatiom to look for retinopathy
b) A through check up for identifying kidney dysfunction and to detect if there is protein leak in urine,
c) Blood pressure assesmment and to keep his BP below 130/80 mm hg , safely
d) Check Cholsterol profile
e) Feet assessment for neuropathy and blood supply
f) Thyroid functions and Prolactin in view of erectile dysfunction.
g) HbA1c
He need Metformin/Januvia combination. This will help to reduce his weight as well. ( however, in view of stomach problems, he may not be able to handle them well. Besides, kidney has to be assessed before starting these medicines)
He need to continue basal bolus insulin. However, in view of nocturnal hypoglycemias. it is better to start on Lantus insulin instead of the current long acting insulin.And I would change his Humulin-R to more short acting Novorapid insulin. That will prevent Hypoglycemia.
Depression and Anxiety could be adding to his bad sugar control and he may benefit from a combination of drugs, counselling, yoga etc. ( i know he hates drugs, but a counselling session may change hs attitude).
Erection problems may be adding to his mental worries. That worry itself worsens sugar control.
HAev you got a cance to look at his recent kidney function tests??
You have to convince him to come over to city to meet an endocrinologist. If not possible, you may change him to a basal bolus insuliin along wth Januvia and Metformin ( if no contraindications).
I know, it is a lengthy list. But diabetes need a comprehensive approach. He is young and unfortunately, has multiple complications. We need to look after the complications and need to prevet new complications. This is possible only with a good blood glucose control along wih Blood pressure and cholsterol control.
Pease feel free to discuss further
Regards
Binu
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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