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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest ways to manage blood pressure in type 2 diabetes patient

Answered by
Dr.
Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Posted on Tue, 6 Sep 2016 in Diabetes
Question: hi. my dad is 69 and has type 2 diabetes and blood pressure. lately he has been having what doc says is postural hypotension in the mornings. but he tests his blood pressure and it is low especially the diastolic goes around 60 and heart rate sometimes in the morning is low as 50. he believes its his belatoc causing the problems. he was taking 50mg morning and night. but after he almost had a fall because od a dizzy spell in the morning and the heart rate being so low in the morning he decided to reduce his dose to 25mg at lunch and night and not to take betaloc in the morning. dr had considered reducing dosage earlier but dad was concerned as his blood pressure does go up sometimes. he is on the following med
atacand 32mg morning, aspiring 100mg morning, dithizide 25mg morning, zanidip 10mg night, metforming 850mg night, gliclazide 80mg morning.
he says after reducing his dosage of betaloc.. his bp that is normally round 135-140/60-65 is now 140-148/70 .. he has been adviced to sit before standing in the morning from bed and not to stand for too long but is he doing the right thing by reducing his betaloc or should he continur on 50mg twice a day but take it morning and night instead? or is it possible to increase zanidip to 20mg and reduce betaloc to 25mg twice a day?
doctor
Answered by Dr. Shehzad Topiwala 37 minutes later
Brief Answer:
Blood pressure

Detailed Answer:
Sorry to learn about your dad's bothersome symptoms.

It is not possible to manage an individual's blood pressure (BP) at an online forum such as this one.

He will need close follow up during the medication readjustment phase. He will need to see his doctor frequently during this time with twice daily BP readings.

But I will advise a couple things:

1 Betaloc should not be stopped abruptly or it can cause problems. I know he is reducing the dose and not stopping it entirely but even then this should all be done under professional medical guidance

2 He should check his blood glucoses levels with a meter at the time of his symptoms . It could be well be due to hypoglycemia ie low sugar reaction.
When I see someone like your dad in my practice, I typically order the following blood tests in addition to a detailed physical examination:

CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
12 hour Fasting Lipid profile
Urine albumin to Creatinine Ratio (early sign of diabetes affecting the kidney)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala 40 minutes later
thanks. i understand its hard to give advice regarding this in this setting. he checks his glucose and it remains around 5 most of the time and is pretty well controlled. havent seen it too low. also what can happen adversely if he reduces his betaloc? he reduced because he was concerned about his low heart rate and the postural hypotension
doctor
Answered by Dr. Shehzad Topiwala 10 hours later
Brief Answer:
Follow up

Detailed Answer:
I understand the glucoses are well controlled but it is important to note exactly how much it is at the time of symptoms.

Suddenly stopping betaloc can lead to rebound increase in BP. I see he is not suddenly stopping it but still a physicians guidance is required even while tapering.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala 5 hours later
ok. also does orthostatic hypo or low blood sugar cause heart rate to fall?
doctor
Answered by Dr. Shehzad Topiwala 4 hours later
Brief Answer:
Second follow up

Detailed Answer:
No. On the contrary, heart rate increases in these two situations
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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