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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes PP sugar levels to be lower than fasting sugar levels?

Answered by
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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 1998 Questions

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Posted on Sat, 9 Jun 2018 in General Health
Question: Hello Dr

i am a 39 year old male..I am having subclinical hypothyroidism and hypertension for past 20 years..My blood sugar fasting is 92mg and pp is only 73mg..I WANT TO ASK YOU WHY MY PP SUGAR IS LESS THAN FASTING SUGAR..Its always less whenever i test my blood sugar in labs..

My creatinine is 1.28 which is high..Kindly tell me is it XXXXXXX phenomenon ? I am taking thyronorm 75mcg and telma h 80..I also take fluvoxamine for anxiety..

kindly tell why pp sugar less than fasting..

Also tell if i need a change in medicines..How to lower serum creatinine.
doctor
Answered by Dr. Mirjeta Guni 1 hour later
Brief Answer:
About your concerns:

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
The causes of lower glucose levels include high insulin sensitivity, exaggerated response of insulin and glucagon like peptide 1, defects in
counterregulation, very lean and /or anxious individuals, after
massive weight reduction,ect. XXXXXXX phenomen consists in low glucose levels during the night.
All you can do is to avoid carbohydrate loads , eat regularly meals (5 meals per day without high calorie index foods) in order to prevent the overproduction of insulin by pancreas.
Regarding to levothyroxine dose you need to check TSH level in order to confirm that the dose is right.
Meanwhile some further examinations are needed to find the cause of high creatinine level.
You should see a nephrologist for it.
Hope i have been helpful,
Kind regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Mirjeta Guni 31 minutes later
Dear Doctor

Are you an endocrinologist or diabetologist? My TSH LEVEL is 0.5 with 75mcg dose..My ULTRASOUND KUB is normal..I am.taking combination of telmisartan plus hctz 80mg for high bp...Can you suggest new blood pressure medicine to lower creatinine? Lower pp sugar is it serious or normal phenomenon which happens?

My fasting sugar is always in 90s and pp in 70s..

kindly suggest further action..
doctor
Answered by Dr. Mirjeta Guni 20 hours later
Brief Answer:
Do not worry about glucose levels:

Detailed Answer:
Welcome back,
I am endocrinologist/diabetologist.
I would suggest to continue with 75 mcg of levothyroxine.
Lower postprandial sugar than fasting is not serious, it can be considered a normal phenomenon (as far as the blood sugar is within the lower and the upper limit).
As i mentioned above, you need some further investigations to find out why the creatinine level is high. There are many pathologies causing it (glomerulonephritis, frequent urinary infections, congenital anomalies ect).
You will need a renal ultrasound, urine test, albuminuria in the 24 hour collected urine ect.
Your treating physician will guide you further after a detailed clinical examination.
Best wishes,
Dr.Mirjeta


Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Mirjeta Guni 2 hours later
Do u suggest any medication changes? In 2006 my creatinine level was 1.5mg..When i took statins and fenofibretes it went upto 1.7mg..Then i stopped statin and fibrates..I was on telma amh 40mg..Creatinine came down to 1.4..I was on olmesartan 40 then..Creatinine was 1.3mg..Then physician stopped bp medicine as i lost weight approx 20kgs by exercise...BP was controlled..Creatinine was 1.24mg..Then i gained weight again..I started on telma h 80mg and my creatinine 2 days back was 1.28mg..INTERSTING THING IS MY UREA AND URIC ACID WERE ALWAYS NORMAL..MY UREA IS 18MG AND URIC ACID 6MG..

DO U SUGGEST ANYTHING?

ANY MEDICATION CHANGES...RENAL USG NORMAL.

SO SHOULD I GO FOR URINE TESTS..IS IVP NECESSARY? MY THINKING IS THAT I HAVE CKD OR HYPERTENSIVE NEPHROPATHY...I dont have any urine burning or any infection..But in 2004 i had blood in urine and i took UTI medicines..In 2006 i had klebsiella pneumonia in my urine..I got treated with nitrofurantoin...After that i am ok...

Wat are your suggestions...Thank you this is my last
doctor
Answered by Dr. Mirjeta Guni 24 hours later
Brief Answer:
About creatinine level;

Detailed Answer:
Hi again,
If there is no pathology found than you may continue with Telma 80 (no need for diuretic as the blood pressure is within the normal ranges).
Keep monitoring Creatinine level and urine for hematuria once in three months.
There is no need to check creatinine every 2 days.
Best wishes,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Mirjeta Guni 1 hour later
ONE LAST QUESTION I WANT TO ASK.. IS TELMISARTAN SAFE FOR LONG TERM USE..I HAVE SURFED INTERNET REGARDING MEDICINE..SOME STUDIES SHOW THAT THE DRUG IS ASSOCIATED WITH SOME CANCERS SPECIALLY LUNG PROSTATE AND SKIN CANCERS..OTHER STUDIES DIDN'T FIND A CONNECTION..IS IT SAFE..DO YOU PRESCRIBE IT IN YOUR ROUTINE PRACTICE..

THANKS
doctor
Answered by Dr. Mirjeta Guni 19 hours later
Brief Answer:
About telmisartan:

Detailed Answer:
Hi again,
Yes your concern is right. Telmisartan has been accused to have a greater risk than other ARBs for some types of cancers but the studies have not approved it. It is in use since 1998 (almost 20 years) and there has been a lot of time time to conduct studies.
In contrary, Telmisartan has been found to have activity against a variety of cancers in vitro, including prostate,renal,colon, leukemia,and ovarian cancer.
The mechanisms of telmisartan's anti-cancer activity have been found to include up-regulation of proliferator-activated-receptor (PPAR) pathway, Bcl-2, and caspase activation.
In my experience, to be sincere i haven't conducted any study regarding this problem and i haven't noticed such a connection.
Wish you all the best.
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Mirjeta Guni 20 hours later
Hello Dr i am.ending this thread..My final.query is that should i continue with telmisartan? Do you prescribe it in your routine practice?

Thank you for your assistance.
doctor
Answered by Dr. Mirjeta Guni 8 hours later
Brief Answer:
About telmisartan:

Detailed Answer:
Hello,
Yes, an ARB treatment is recommended to prevent further damages of the kidneys, or to improve its function.
Rather telmisartan or another Angiotensine-renine Blocker, there will not be any significant difference, they have almost the same effect. They role in preventing further renal damage is very important. As it has been efficient until now, i would suggest to continue with it.
Yes, i do suggest it in my everyday practice to prevent diabetic nephropathy (with the same frequency as the other medications of this group).
Keep monitoring Creatinine level once in three months.
Wishing you good health!
Regards,
Dr.Mirjeta



Above answer was peer-reviewed by : Dr. Nagamani Ng
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