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Suggest Treatment For Swelling On Legs And Sleepiness While On Insulin
Question: Hi I have been a Diabetic Patient for the last 8 Years and is on insulin ( Human Mixtard ( Afternoon before Lunch) 30 units and Lanctus 30 Units after Dinner. Also, I am been treated with Janumet 50/1000 once a day. Two years back I had a open heart beating surgery and the following medicines were added on Storvas 20, Ceruvin Af 75/150, Triptomer 10 mg ( as have disturbed sleep). I realised swelling on my right leg over the last couple of days and feel really sleepy and tired throughout the day. Can you advise/help
Brief Answer:
Please do the blood tests
Detailed Answer:
Hi XXXX,
Welcome to HCM. I have gone through the question and understand your concerns.
Mixtard insulin once daily with Lantus insulin is not a recommended insulin therapy in type 2 diabetes. But if your sugars are well controlled on this regimen continue same.
If a diabetic patients develop swelling in legs, we do some examinations and tests
1. Examination:
If your legs are warm, red and swollen it could be due to cellulitis - an infection for which you may need antibiotics.
We will also check your pulses, lower limb veins, nerve function and Cardiac examination
2. Tests
The blood tests needed are Fasting and after food blood glucose, HbA1c, Kidney function tests, blood routine, thyroid function tests, serum albumin and urine protein.
We can make a decision based on these tests.
Hope I have answered your questions. If you have any further queries I will be happy to help you.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Please do the blood tests
Detailed Answer:
Hi XXXX,
Welcome to HCM. I have gone through the question and understand your concerns.
Mixtard insulin once daily with Lantus insulin is not a recommended insulin therapy in type 2 diabetes. But if your sugars are well controlled on this regimen continue same.
If a diabetic patients develop swelling in legs, we do some examinations and tests
1. Examination:
If your legs are warm, red and swollen it could be due to cellulitis - an infection for which you may need antibiotics.
We will also check your pulses, lower limb veins, nerve function and Cardiac examination
2. Tests
The blood tests needed are Fasting and after food blood glucose, HbA1c, Kidney function tests, blood routine, thyroid function tests, serum albumin and urine protein.
We can make a decision based on these tests.
Hope I have answered your questions. If you have any further queries I will be happy to help you.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1) I have an uncontrolled diabetic syndrome, if Human Mixtard and Lanctus are not the right combination, suggest alternatives. The above was suggested by Dr Wangnoo after my Heart Surgery
2) Please also be advised I have been a patient of Psoriasis over the last 40 Years. Swelling in the legs is just water retention as I could see it, is it because of any intake of medicine.
3) Also, over a couple of months I have been having cuts in the foreskin of my penis with white patchy discharge. I went through the net and started treating myself for balanoposthitis by using clotrimazole cream with 2 doses of Fluconazole capsules. The discharge has stopped and the cuts are healing. Am I doing harm by self madication and is this the cause for swollen legs ( NOT SO MUCH THOUGH)
2) Please also be advised I have been a patient of Psoriasis over the last 40 Years. Swelling in the legs is just water retention as I could see it, is it because of any intake of medicine.
3) Also, over a couple of months I have been having cuts in the foreskin of my penis with white patchy discharge. I went through the net and started treating myself for balanoposthitis by using clotrimazole cream with 2 doses of Fluconazole capsules. The discharge has stopped and the cuts are healing. Am I doing harm by self madication and is this the cause for swollen legs ( NOT SO MUCH THOUGH)
Brief Answer:
Control the diabetes first
Detailed Answer:
Hi XXXX,
Welcome back.
All your symptoms may be the result is in controlled diabetes. Please check your HbA1c, which will give you and idea on diabetic control and help you with follow up.
Regarding insulin regimens - there are 2 groups of insulins available in our market. Human insulins ( Actrapid, insulatard and Mixtard, etc) and the expensive analogue insulins ( novo rapid, novo mix, Lantus etc). Yhe choice is based on the financial status. In either groups there are insulin that can be used once or twice or thrice daily.
Mixtard is an insulin used twice daily - morning before breakfast and before dinner. Lantus is an analogue insulin used once daily along with oral medications. If your sugars are not controlled with once daily Lantus you have to change to twice daily Mixtard or Novomix. If still uncontrolled - you can take Novorapid or Actrapid thrice daily along with Lantus once daily. These are the insulin regimens recommended.
If you feel the swelling in legs is not due to an infection, you can wait for diabetes to get controlled. Once controlled the balanopostitis will also subside. The medications you have said do not cause leg swelling.
It is better to consult a physician and adjust the medication. Online forums and consultations can only help you in understanding better on your medical condition.
Regards
Dr Ajish TP
Control the diabetes first
Detailed Answer:
Hi XXXX,
Welcome back.
All your symptoms may be the result is in controlled diabetes. Please check your HbA1c, which will give you and idea on diabetic control and help you with follow up.
Regarding insulin regimens - there are 2 groups of insulins available in our market. Human insulins ( Actrapid, insulatard and Mixtard, etc) and the expensive analogue insulins ( novo rapid, novo mix, Lantus etc). Yhe choice is based on the financial status. In either groups there are insulin that can be used once or twice or thrice daily.
Mixtard is an insulin used twice daily - morning before breakfast and before dinner. Lantus is an analogue insulin used once daily along with oral medications. If your sugars are not controlled with once daily Lantus you have to change to twice daily Mixtard or Novomix. If still uncontrolled - you can take Novorapid or Actrapid thrice daily along with Lantus once daily. These are the insulin regimens recommended.
If you feel the swelling in legs is not due to an infection, you can wait for diabetes to get controlled. Once controlled the balanopostitis will also subside. The medications you have said do not cause leg swelling.
It is better to consult a physician and adjust the medication. Online forums and consultations can only help you in understanding better on your medical condition.
Regards
Dr Ajish TP
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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