Hi XXXXXXX,
Welcome to XXXXXXX forum.

Let me explain your query one by one.

Do you have positive family history of early heart disease? (Early heart disease is considered in female <65 years and in male <55 years).
Do you have an active or sedentary life?
Are you a smoker?

With the available described symptoms and blood investigations, there appears to be some discrepancy in lipid profile report.
As you have mentioned that you were taking Atorvastatin since 3 years and you have elevated values when lipid profile was done few months back; How it could be possible that your deranged lipid profile comes to normal range after taking Atorvastatin + Fenofibrate for few months (while not correcting after taking 3 years)?

Treatment of Dyslipidemia (deranged lipid profile) is decided by presence / absence of risk factors.
Smoking, age > 45 years, sedentary life, first degree relative with positive early heart disease 140/90 mm Hg, Diabetes are considered as risk factors.

Normal BMI is between 18.5 -25.
Your BMI (Basal metabolic rate) is 26.95; which is slightly higher and you will be categorized in overweight.
You have one risk factor (overweight).

Presently you are non diabetic and at the age of 49 years, there is high chances of getting Type II diabetes (type I occurs before the age of 30 years) and this is generally diagnosed accidentally and with occurrence of complications such as heart attack, stroke, kidney damage, gastrointestinal symptoms.
As such type II diabetes has no symptoms.
You should go for repeat blood sugar both fasting and postprandial at regular interval.

Treatment of Dyslipidemia is decided by LDL level and should read ATP III guidelines.
If < 2 risk factors are present then LDL should be < 160 mg%.
If > 2 risk factors with 10 year risk of developing heart disease is <20% then LDL should be <130 mg%.
If > 2 risk factors with 10 year risk of developing heart disease is >20%, diabetes then LDL should be <100 mg%.
You can download calculator from following site: WWW.WWWW.WW For very high risk patients, LDL should be < 70 mg%.

As you have only one risk factor, your LDL must be below 160 mg%.
Your LDL is 106 mg% and as such there is no need of anti lipid lowering medicines.
Total cholesterol should be < 200 mg% (your value is 179 mg%) and triglycerides should be < 150 mg% (your value is 160 mg%).
So if we consider present lipid profile report, you should continue Atorvastatin as for maintenance therapy.


As you are overweight with slight derangements of lipid profile, you should reduce your weight.
Life style modifications are required in your case.
You should take low fat diet and live physically active life.
You should continue brisk exercise 30 minutes per day, at least 5 days in a week.

As there is some discrepancy, you should go for repeat lipid profile from a different lab.

You should consult with XXXXXXX medicine specialist/ cardiologist and should remain in touch.

Hope that helps.
Let me know if I can address any more concerns.
Take care,
Dr. Mayank Bhargava

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Hi,
Let me know that this 260 mg% sugar is fasting or postprandial (exactly 2 hours after meals).
Blood sugar 260 mg% whether it is fasting or postprandial suggests diabetes.
Fasting blood sugar > 126 mg% and postprandial blood sugar > 200 mg% is diagnostic for diabetes.
You should also go for glycosylated hemoglobin (HbA1c).
Raised serum creatinine may suggest effect of diabetes on kidney and you should go for ultrasound imaging for detection of preservation of cortico-meduulary differentiation and size of kidney.
Kidney size < 8.5 cm with loss of cortico-medullary differentiation suggests chronic kidney disease (CKD).
Although in diabetes, kidney size may be more than 8.5 cm in case of CKD.

Let men know the results of ultrasound imaging and glycosylated hemoglobin (HbA1c).

Best regards,
Dr. Mayank Bhargava

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Hi,
Glibenclamide is a sulfonylurea: a group of medicines used for control of blood sugar.
Other sulfonylureas are glipizide and glimipride and different doctors have different experience with these drugs.
Selection of a particular drug depends on treating doctor's choice.
I am well acquainted with Glimipride with very good experience; keeping fasting at 100-110 mg% and postprandial around 140-150 mg%.
You should continue prescribed medicines as advised by your treating doctor.
Sulfonylureas are taken 30 minutes before meals (breakfast/ lunch/ dinner).
Currently medical nutrition therapy (MNT) is advised in which patient's diet is decided by total calories.
So you can take whatever you like but with limited calories.
You should consult with your treating doctor or dietitian for MNT.
Best regards,
Dr. Mayank Bhargava

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