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What Causes Muscle Weakness, Lack Of Appetite And Stomach Ache?
Question: Hello,
My mother (63 yrs) is diabetic.. She was told to take Instamet G1 (Twice) & Instamet-500 SR... but she is hardly regular in taking medicine off and on.. not regularly..
For the last two months she was feeling weakness in muscles ( leg nerves), does not like the taste of food and thus not eating much.. Weather is also cold here...
4-5 days back she complained of stomach ache ( may be gas).
We got fasting sugar & urine checked. Report dated 22.01.2015 is as follows
-Fasting Sugar = 398.00 mg/dl ( too high)
-HBA 1 C = 9.10% (Poor Control)
-S.Urea = 59.00 mg/dl
-S.Creatinine = 2.28 mg/dl
URINE Chemical examination
Sugar (+++)
Albumin (+)
Now She is taking the same medicine Instamet G1 ( Twice), Instamet - 500 SR (once) & Nokicef -O & OMESEC - RD
Fasting has come down to : 239 mg/dl
Still on same medicine but she still not liking the food taste and weakness is still there..
My mother (63 yrs) is diabetic.. She was told to take Instamet G1 (Twice) & Instamet-500 SR... but she is hardly regular in taking medicine off and on.. not regularly..
For the last two months she was feeling weakness in muscles ( leg nerves), does not like the taste of food and thus not eating much.. Weather is also cold here...
4-5 days back she complained of stomach ache ( may be gas).
We got fasting sugar & urine checked. Report dated 22.01.2015 is as follows
-Fasting Sugar = 398.00 mg/dl ( too high)
-HBA 1 C = 9.10% (Poor Control)
-S.Urea = 59.00 mg/dl
-S.Creatinine = 2.28 mg/dl
URINE Chemical examination
Sugar (+++)
Albumin (+)
Now She is taking the same medicine Instamet G1 ( Twice), Instamet - 500 SR (once) & Nokicef -O & OMESEC - RD
Fasting has come down to : 239 mg/dl
Still on same medicine but she still not liking the food taste and weakness is still there..
Brief Answer:
It is better to start on insulin
Detailed Answer:
Hi,
Welcome to HCM. I had gone through your question and understand your concerns.
The problems with your mother's diabetic condition:
1. Uncontrolled diabetes
2. Elevated creatinine - kidney damage
3. Albumin in urine - another sign of kidney damage
4. Diabetic neuropathy - nerve damage
5. Probably diabetic myopathy - muscle disease in diabetes
Currently she should immediately be started on Insulin. Once creatinine is more than 1.5 mg/dl, her current medications cannot be continued. So Instamet G1 and Instamet has to be stopped. If on follow up the creatine comes down below 1.5 mg/dl we can restart on medications.
Once the sugars are normalised on insulin, the symptoms of muscle pain will come down.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
It is better to start on insulin
Detailed Answer:
Hi,
Welcome to HCM. I had gone through your question and understand your concerns.
The problems with your mother's diabetic condition:
1. Uncontrolled diabetes
2. Elevated creatinine - kidney damage
3. Albumin in urine - another sign of kidney damage
4. Diabetic neuropathy - nerve damage
5. Probably diabetic myopathy - muscle disease in diabetes
Currently she should immediately be started on Insulin. Once creatinine is more than 1.5 mg/dl, her current medications cannot be continued. So Instamet G1 and Instamet has to be stopped. If on follow up the creatine comes down below 1.5 mg/dl we can restart on medications.
Once the sugars are normalised on insulin, the symptoms of muscle pain will come down.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir, thanks for prompt reply...
1. We are not sure if its uncontrolled diabetes as she had never taken medicine seriously.. Also, as mentioned with present medication fasting sugar is down to 239 mg/dl.
2. I forgot to mention:
RBC's : 1-2/hpf
Puscells : 20-25/hpf
3. PLEASE advise if giving Insulin will be temporary ( i.e tapered off) or she will be dependent on it.
4. FINALLY,
As per RFT dated 21.10.2014
Creatinine : 1.40
S. Urea : 37.00
As per RFT dated 22.01.2015 ( i.e three months after 21.10.2014)
Creatinine : 2.28
S. Urea : 59.00
As mentioned above within three months the creatnine is high... Does it mean kidney not working properly temporarily right now due to low insulin or its an irreparable loss to kidney..
1. We are not sure if its uncontrolled diabetes as she had never taken medicine seriously.. Also, as mentioned with present medication fasting sugar is down to 239 mg/dl.
2. I forgot to mention:
RBC's : 1-2/hpf
Puscells : 20-25/hpf
3. PLEASE advise if giving Insulin will be temporary ( i.e tapered off) or she will be dependent on it.
4. FINALLY,
As per RFT dated 21.10.2014
Creatinine : 1.40
S. Urea : 37.00
As per RFT dated 22.01.2015 ( i.e three months after 21.10.2014)
Creatinine : 2.28
S. Urea : 59.00
As mentioned above within three months the creatnine is high... Does it mean kidney not working properly temporarily right now due to low insulin or its an irreparable loss to kidney..
Brief Answer:
Please see detailed answers
Detailed Answer:
Hi,
Welcome back.
Understood your concerns.
The detailed answer for your questions.
1. Fasting sugars of 239 mg/dl is too high (Even though you have brought it down from 398 mg/dl).
Controlled diabetes is fasting sugars less than 130 mg/dl, after food less than 180 mg/dl and an HbA1C of less than 7%. Any thing more than this is uncontrolled diabetes - here it is well above this target.
Other things like elevated creatinine, albumin in urine , muscle pain etc suggests uncontrolled diabetes. Don't worry you can bring it down with proper medications and insulin
2. She is having urinary infection. Already she is started on antibiotics (Nokicef O). It is better to do a urine culture also. Urinary infection could be a reason for uncontrolled sugars and worsening of serum creatinine. Treating the infection will help to improve these parameters.
3. Permanent or temporary insulin
This depends on how long she is having uncontrolled diabetes and how good is her pancreatic function. In person who is irregular with medications and high sugars, usually once sugars are controlled the pancreatic function improves and then sugars can be controlled with oral medications. We prefer insulin to bring down high sugars, irrespective of whether this is a recent or long standing uncontrolled diabetes. This will give rest to pancreas and will help the pancreatic function to recover.
In your mother's case the best option is to start on insulin and follow up with sugars and serum creatinine values. When creatinine is less than 1.8 mg/dl (ideally 1.5) we can restart on oral medications and taper down the insulin dose.
If her creatinine was normal, we could still have given her a trial of regular oral medications. Here insulin is essential as there is elevated creatinine and presence of urinary infection.
4. At present kidney function is decreased. That is reflected by increased creatinine. Don't worry, this could be an effect of urinary infection and recent uncontrolled diabetes. Once it is controlled the kidney function may return to normal.
Wishing her early recovery.
Regards
Dr Ajish TP
Please see detailed answers
Detailed Answer:
Hi,
Welcome back.
Understood your concerns.
The detailed answer for your questions.
1. Fasting sugars of 239 mg/dl is too high (Even though you have brought it down from 398 mg/dl).
Controlled diabetes is fasting sugars less than 130 mg/dl, after food less than 180 mg/dl and an HbA1C of less than 7%. Any thing more than this is uncontrolled diabetes - here it is well above this target.
Other things like elevated creatinine, albumin in urine , muscle pain etc suggests uncontrolled diabetes. Don't worry you can bring it down with proper medications and insulin
2. She is having urinary infection. Already she is started on antibiotics (Nokicef O). It is better to do a urine culture also. Urinary infection could be a reason for uncontrolled sugars and worsening of serum creatinine. Treating the infection will help to improve these parameters.
3. Permanent or temporary insulin
This depends on how long she is having uncontrolled diabetes and how good is her pancreatic function. In person who is irregular with medications and high sugars, usually once sugars are controlled the pancreatic function improves and then sugars can be controlled with oral medications. We prefer insulin to bring down high sugars, irrespective of whether this is a recent or long standing uncontrolled diabetes. This will give rest to pancreas and will help the pancreatic function to recover.
In your mother's case the best option is to start on insulin and follow up with sugars and serum creatinine values. When creatinine is less than 1.8 mg/dl (ideally 1.5) we can restart on oral medications and taper down the insulin dose.
If her creatinine was normal, we could still have given her a trial of regular oral medications. Here insulin is essential as there is elevated creatinine and presence of urinary infection.
4. At present kidney function is decreased. That is reflected by increased creatinine. Don't worry, this could be an effect of urinary infection and recent uncontrolled diabetes. Once it is controlled the kidney function may return to normal.
Wishing her early recovery.
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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