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Suggest Remedy For Uncontrolled Diabetes And Iron Deficiency
Question: Hi
I am a 59 year old woman. I have been a diabetic since 1998. There is no family history. My weight is currently 53, my height 5 feet 1 inch.
Initially I was on various oral medicines like semidianil, amaryl, etc. From 200 I was on various doseds of insulin along with metformin. In 2009, I underwent abdominoplasty and my weight came down from 69 to 60 kilos and my sugar levels dropped to HbA1c of 8. Since then my weight dropped for the next six months till I reached my present weight which has remained more or less constant for over 6 years now.
I was taken off insulin in 2009 and since then managed to control my fasting and PP readings with galvus 50 and Duotrol 1 tablet twice a day, along with a controlled diet and some exercise. My diet remains highly disciplined -- mostly vegetables a little rice, a helping of permitted of fruit.
Yet, My sugar levels are now hovering between 230 and 370. The only lifestyle setback is decreased sleep and exercise due to work over load. But no weight increase. I do not smoke or drink. I attained menopause about 6-7 years ago.
Even increasing galvus and dutrol do not help bring sugar reading. Have these become ineffective for me due to long use of over 5 years? will a change of medcation help?I am uploading my report. Please let me know if there is a way of bringing down and stabilising my sugar. I live in XXXXXXX -- so please prescribe medicines that will be available her.
I am uploading my last report that include a complete profileincluding urea creatinine etc.
Regds Ansura
I am a 59 year old woman. I have been a diabetic since 1998. There is no family history. My weight is currently 53, my height 5 feet 1 inch.
Initially I was on various oral medicines like semidianil, amaryl, etc. From 200 I was on various doseds of insulin along with metformin. In 2009, I underwent abdominoplasty and my weight came down from 69 to 60 kilos and my sugar levels dropped to HbA1c of 8. Since then my weight dropped for the next six months till I reached my present weight which has remained more or less constant for over 6 years now.
I was taken off insulin in 2009 and since then managed to control my fasting and PP readings with galvus 50 and Duotrol 1 tablet twice a day, along with a controlled diet and some exercise. My diet remains highly disciplined -- mostly vegetables a little rice, a helping of permitted of fruit.
Yet, My sugar levels are now hovering between 230 and 370. The only lifestyle setback is decreased sleep and exercise due to work over load. But no weight increase. I do not smoke or drink. I attained menopause about 6-7 years ago.
Even increasing galvus and dutrol do not help bring sugar reading. Have these become ineffective for me due to long use of over 5 years? will a change of medcation help?I am uploading my report. Please let me know if there is a way of bringing down and stabilising my sugar. I live in XXXXXXX -- so please prescribe medicines that will be available her.
I am uploading my last report that include a complete profileincluding urea creatinine etc.
Regds Ansura
Brief Answer:
Uncontrolled diabetes & Iron Deficiency.
Detailed Answer:
Hi,
Thanks for your question.
After going through your question, I can understand your concern.
There are 2 main issues
- Uncontrolled blood sugar levels.
- Iron deficiency.
* As far as your blood glucose control is concerned -
- Your wight is under control considering your height ( BMI 22.78).
- You are following diabetic diet.
- Following regular exercise as per your effort tolerance.
- So only scope is to do changes in your antidiabetic medications.
Contents of your Antidiabetic medicines-
Tab Galvus contains Vildagliptin.
Tab Duotrol contains Glibenclamide and Metformin.
*Reason for your uncontrolled blood sugar levels may be-
-Diabetes is a progressive disease has two important pathogenic steps-
1) Insulin resistance: Increased demand of insulin by body.
2) Pancreatic dysfunction: Decreased insulin secretion by pancreas.
-As age & duration of diabetes advances there is progressive worsening of insulin secretion from pancreas.
- This leads to failure of medicines which act on pancreas to secret extra insulin like Glibenclamide (component of Duotrol) in your case.
That is pancreas secretes very minimal amount of insulin even with stimulus from medicines which is inadequate to control blood sugar.
That's why there is rising blood sugar levels despite increasing doses of your medicines.
If patient with similar situation presents to me, I would have recommended -
1) To stop tab Duotrol.
2) Continue Tab Galvus 50mg twice a day.
3) Add tab containing Metformin 1 gram twice a day.
4) Add night dose of long acting insulin like glargin depending upon fasting & premeal blood sugar level.
Even with these changes there might be need for addition of short acting insulin before each meal depending upon 2 hour post meal blood sugar levels.
Also there is need for increasing iron intake in food along with iron supplement.
You should consult near by diabetologist and discuss all this with him.
Hope this helps you.
Regards,
Dr. Abhay Mali.
Diabetologist.
Uncontrolled diabetes & Iron Deficiency.
Detailed Answer:
Hi,
Thanks for your question.
After going through your question, I can understand your concern.
There are 2 main issues
- Uncontrolled blood sugar levels.
- Iron deficiency.
* As far as your blood glucose control is concerned -
- Your wight is under control considering your height ( BMI 22.78).
- You are following diabetic diet.
- Following regular exercise as per your effort tolerance.
- So only scope is to do changes in your antidiabetic medications.
Contents of your Antidiabetic medicines-
Tab Galvus contains Vildagliptin.
Tab Duotrol contains Glibenclamide and Metformin.
*Reason for your uncontrolled blood sugar levels may be-
-Diabetes is a progressive disease has two important pathogenic steps-
1) Insulin resistance: Increased demand of insulin by body.
2) Pancreatic dysfunction: Decreased insulin secretion by pancreas.
-As age & duration of diabetes advances there is progressive worsening of insulin secretion from pancreas.
- This leads to failure of medicines which act on pancreas to secret extra insulin like Glibenclamide (component of Duotrol) in your case.
That is pancreas secretes very minimal amount of insulin even with stimulus from medicines which is inadequate to control blood sugar.
That's why there is rising blood sugar levels despite increasing doses of your medicines.
If patient with similar situation presents to me, I would have recommended -
1) To stop tab Duotrol.
2) Continue Tab Galvus 50mg twice a day.
3) Add tab containing Metformin 1 gram twice a day.
4) Add night dose of long acting insulin like glargin depending upon fasting & premeal blood sugar level.
Even with these changes there might be need for addition of short acting insulin before each meal depending upon 2 hour post meal blood sugar levels.
Also there is need for increasing iron intake in food along with iron supplement.
You should consult near by diabetologist and discuss all this with him.
Hope this helps you.
Regards,
Dr. Abhay Mali.
Diabetologist.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Than you doctor.
Please tell me which is the insulin I should buy and what dose? please give names and doses for both short and long acting insulin. Also the name of iron supplement.
I get severe leg pains and my limbs, particularly legs seem to be going thinner, even though I am not doing anything to lose weight on my legs which are already like sticks. Should I do / take something to build strength or muscles in the legs? I get sever deep pains in the calf and thighs. I am taking vit d supplement,
Please tell me which is the insulin I should buy and what dose? please give names and doses for both short and long acting insulin. Also the name of iron supplement.
I get severe leg pains and my limbs, particularly legs seem to be going thinner, even though I am not doing anything to lose weight on my legs which are already like sticks. Should I do / take something to build strength or muscles in the legs? I get sever deep pains in the calf and thighs. I am taking vit d supplement,
Brief Answer:
Insulin Glargine...
Detailed Answer:
Hi,
Thanks.
For blood sugar control-
- I would start with Insulin Glargine (Lantus / Basugine) a long acting insulin 8 units at 10 pm.
- There is a need for home blood sugar monitoring using glucometer.
- After starting glargine, I would suggest that we do at least 2 to 3 readings per day from following readings-
Fasting
2 hours after break fast
Before Lunch
2 hours after lunch
Before Dinner
2 hours after dinner.
- According to blood sugar chart appropriate dose adjustment in insulin glargine can be done along with that need for short acting insulin (Human Actrapid / Novorapid) to control post meal blood sugar levels can be evaluated. Discuss these options with your treating doctor.
- Continue oral medicines as advised before.
Iron Supplement-
I would start Tab Orofer XT
For leg pain-
- There is most likely muscle wasting in your case.
- Diabetic Amyotrophy (Diabetic Proximal Myopathy) a form of diabetic neuropathy should be considered.
- There is a need for detailed neurological evaluation to confirm the diagnosis.
- Continue Vitamin D & Vitamin B12 supplement.
Over all you need to consult near by diabetologist / endocrinologist for detailed clinical and neurological evaluation, discuss all your issue with him, depending upon it appropriate decision can be taken.
Hope this helps you.
Insulin Glargine...
Detailed Answer:
Hi,
Thanks.
For blood sugar control-
- I would start with Insulin Glargine (Lantus / Basugine) a long acting insulin 8 units at 10 pm.
- There is a need for home blood sugar monitoring using glucometer.
- After starting glargine, I would suggest that we do at least 2 to 3 readings per day from following readings-
Fasting
2 hours after break fast
Before Lunch
2 hours after lunch
Before Dinner
2 hours after dinner.
- According to blood sugar chart appropriate dose adjustment in insulin glargine can be done along with that need for short acting insulin (Human Actrapid / Novorapid) to control post meal blood sugar levels can be evaluated. Discuss these options with your treating doctor.
- Continue oral medicines as advised before.
Iron Supplement-
I would start Tab Orofer XT
For leg pain-
- There is most likely muscle wasting in your case.
- Diabetic Amyotrophy (Diabetic Proximal Myopathy) a form of diabetic neuropathy should be considered.
- There is a need for detailed neurological evaluation to confirm the diagnosis.
- Continue Vitamin D & Vitamin B12 supplement.
Over all you need to consult near by diabetologist / endocrinologist for detailed clinical and neurological evaluation, discuss all your issue with him, depending upon it appropriate decision can be taken.
Hope this helps you.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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