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What Does My Blood Test Report Indicate?
Question: Dear Doctor
Good Day to you. I am a diabetic patient for the last 20 years now.
My Age is 55; Wt -72 Kg and Height is 5.5 Ft.
My latest blood report showing the following adverse reports are as follows:
Triglycerides-228 which have reduced from 377
LDL-45.68
TSH-7.85 Increased from 7.18
Blood Sugar -Fasting -180
PP-240
HBA1C- 7.5
Presently I am on medication as follows:
1. For Triglycerides-Fibrovas- once daily at night. (Tablet of Fenofibrate and Atorvastatin)
2. For TSH- Thyronorm- Once daily in the morning on empty stomac. (Twice on Saturday and Sunday).
3. No Tablest for LDL
4. For Diabetics
Novomix Insulin Injection 3mg- 20 Units X2 once in the Morning and Once in the Evening. (Mixture of Insulin Aspart and Protamine Crystallised.
Oral Tablet- Azulix 4 MF. Once in the Morning and Once in the Evening. (Glimepiride -4 MG and Metformin-500 MG).
Recently I had been advised to change the medicine to the following as my sugar level was constantly on the rise despite the above medication.
The new Medicine I am advised as follows:
Novomix 30- 20 Units in the Morning and 16 Units in the Evening along with the following Oral tablets.
Glycomet GP-1 - One Tablet in the morning (Glimepiride 1 Mg and Metformin-1000 Mg) AND
Jalra-M - One Tablet in the Evening (Vildagliptin-50 Mg and Metformin-1000 Mg).
I have not yet started the above medicine yet and seek a second opinion before I could start any new medication as I feel with highter amount of metformin it could damage my kidney and increase the creatinine level.
I have been on Insulin for the last 3 years. Initially it showed improvement but now the sugar is not going below 180 in fasting for the last six months. Last year I got pacemaker implanted and it has reduced further my mobility to undertake strenuous exercise and brisk walking. I get tired easily after walking for 5 to 10 minutes at a stretch. Also I frequently suffer from dry allergic cough which has become a constant irritant for me.
Could you please advice what course of action should I take to make my self cure of the above problems and also at the same time I can reduced the insulin intake with a controlled sugar level.
I have a feeling my prescription is not proper as it is not been able to reduce my blood sugar as such.
As exercise I do Yoga and walking for 30 mts. Some time it gets skipped. Also I am very right on my diet.
An early reply would be highly appreciate.
Kind Regards XXXXXXX XXXXXXX
Present Medication
TSH-
Good Day to you. I am a diabetic patient for the last 20 years now.
My Age is 55; Wt -72 Kg and Height is 5.5 Ft.
My latest blood report showing the following adverse reports are as follows:
Triglycerides-228 which have reduced from 377
LDL-45.68
TSH-7.85 Increased from 7.18
Blood Sugar -Fasting -180
PP-240
HBA1C- 7.5
Presently I am on medication as follows:
1. For Triglycerides-Fibrovas- once daily at night. (Tablet of Fenofibrate and Atorvastatin)
2. For TSH- Thyronorm- Once daily in the morning on empty stomac. (Twice on Saturday and Sunday).
3. No Tablest for LDL
4. For Diabetics
Novomix Insulin Injection 3mg- 20 Units X2 once in the Morning and Once in the Evening. (Mixture of Insulin Aspart and Protamine Crystallised.
Oral Tablet- Azulix 4 MF. Once in the Morning and Once in the Evening. (Glimepiride -4 MG and Metformin-500 MG).
Recently I had been advised to change the medicine to the following as my sugar level was constantly on the rise despite the above medication.
The new Medicine I am advised as follows:
Novomix 30- 20 Units in the Morning and 16 Units in the Evening along with the following Oral tablets.
Glycomet GP-1 - One Tablet in the morning (Glimepiride 1 Mg and Metformin-1000 Mg) AND
Jalra-M - One Tablet in the Evening (Vildagliptin-50 Mg and Metformin-1000 Mg).
I have not yet started the above medicine yet and seek a second opinion before I could start any new medication as I feel with highter amount of metformin it could damage my kidney and increase the creatinine level.
I have been on Insulin for the last 3 years. Initially it showed improvement but now the sugar is not going below 180 in fasting for the last six months. Last year I got pacemaker implanted and it has reduced further my mobility to undertake strenuous exercise and brisk walking. I get tired easily after walking for 5 to 10 minutes at a stretch. Also I frequently suffer from dry allergic cough which has become a constant irritant for me.
Could you please advice what course of action should I take to make my self cure of the above problems and also at the same time I can reduced the insulin intake with a controlled sugar level.
I have a feeling my prescription is not proper as it is not been able to reduce my blood sugar as such.
As exercise I do Yoga and walking for 30 mts. Some time it gets skipped. Also I am very right on my diet.
An early reply would be highly appreciate.
Kind Regards XXXXXXX XXXXXXX
Present Medication
TSH-
Brief Answer:
You may follow new prescription.
Detailed Answer:
Hi Mr. XXXXXXX XXXXXXX
Thanks for your question.
Noted your concern.
Your Triglyceride level is still high but with better blood sugar control and use of Fenofibrate it can be further lowered.
LDL level of 45.68 is really good for prevention of macrovascular complications like heart attack, stroke. Keep using Atorvastatin (which help in lowering LDL).
For Thyroid problem there is a need to increase the dose of Tab Thyronorm depending upon current dose while doing this the underlying heart status for which pacemaker is implanted need to be considered.
Your HbA1c of 7.5 look good for 20 yrs of diabetes, though with the mentioned Fasting and PP BSL levels there is a chance of further improvement.
Metformin is a first line treatment for Type 2 diabetes mellitus.
Metformin itself do not have bad effect on kidney or increases cratinine but deranged kidney function (elevated serum creatinine level) by diabetes, blood pressure or due to other causes increases the chances of side effects of metformin.
So metformin is avoided with elevated serum creatinine level.
Metformin side effects may be increased with poor heart function (Pumping capacity of heart denoted by Ejection fraction in 2DEcho).
If your serum creatinine and Ejection Fraction is normal then there is no restriction to use of Metformin 2gram per day as advised to you in new prescription.
Regarding Glimepiride I may not use it in such a high dose (8 mg per day as you are currently taking).
Vildagliptin is a good option as advised to you. Its dose need to be increased in future depending upon blood sugar level.
In short you can follow your new prescription (Novomix, Jalra M, Glycomet GP1) if serum creatinine is blow 1.5 and Ejection fraction is normal.
Along with it follow strictly diabetic diet, regular exercise as currently following.
You should keep in mind as duration of diabetes advances there is progressive deterioration of insulin secretion by pancreas and there may be need to increase dose of current medications and insulin depending upon blood sugar level.
Regarding dry cough there is a need for detailed clinical examination depending upon it appropriate decision can be made.
Hope this helps you.
I will be happy to answer your future queries, if any.
Regards,
Dr. Abhay Mali.
Diabetologist.
You may follow new prescription.
Detailed Answer:
Hi Mr. XXXXXXX XXXXXXX
Thanks for your question.
Noted your concern.
Your Triglyceride level is still high but with better blood sugar control and use of Fenofibrate it can be further lowered.
LDL level of 45.68 is really good for prevention of macrovascular complications like heart attack, stroke. Keep using Atorvastatin (which help in lowering LDL).
For Thyroid problem there is a need to increase the dose of Tab Thyronorm depending upon current dose while doing this the underlying heart status for which pacemaker is implanted need to be considered.
Your HbA1c of 7.5 look good for 20 yrs of diabetes, though with the mentioned Fasting and PP BSL levels there is a chance of further improvement.
Metformin is a first line treatment for Type 2 diabetes mellitus.
Metformin itself do not have bad effect on kidney or increases cratinine but deranged kidney function (elevated serum creatinine level) by diabetes, blood pressure or due to other causes increases the chances of side effects of metformin.
So metformin is avoided with elevated serum creatinine level.
Metformin side effects may be increased with poor heart function (Pumping capacity of heart denoted by Ejection fraction in 2DEcho).
If your serum creatinine and Ejection Fraction is normal then there is no restriction to use of Metformin 2gram per day as advised to you in new prescription.
Regarding Glimepiride I may not use it in such a high dose (8 mg per day as you are currently taking).
Vildagliptin is a good option as advised to you. Its dose need to be increased in future depending upon blood sugar level.
In short you can follow your new prescription (Novomix, Jalra M, Glycomet GP1) if serum creatinine is blow 1.5 and Ejection fraction is normal.
Along with it follow strictly diabetic diet, regular exercise as currently following.
You should keep in mind as duration of diabetes advances there is progressive deterioration of insulin secretion by pancreas and there may be need to increase dose of current medications and insulin depending upon blood sugar level.
Regarding dry cough there is a need for detailed clinical examination depending upon it appropriate decision can be made.
Hope this helps you.
I will be happy to answer your future queries, if any.
Regards,
Dr. Abhay Mali.
Diabetologist.
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Doctor
Thanks for your reply. I have started the new medication from today.
However I have some further queries as follows:
1. I am told by my doctor that Insulin Injection which I am taking (Novomix 30) has been a mild dose insulin and it is not effective for long period.
2. Jalra M- the medicine which he has given me can bring flatulence or heaviness in my stomach.
Pl advice if that is the case, which other alternative medicine, I should use.
I am also attaching my complete blood report along with this mail. Kindly go through it and advice if I need any further medication, apart from what has already been prescribed.
For follow up, kindly let me know the procedure.
An early reply would be highly appreciated.
Kind Regards
Thanks for your reply. I have started the new medication from today.
However I have some further queries as follows:
1. I am told by my doctor that Insulin Injection which I am taking (Novomix 30) has been a mild dose insulin and it is not effective for long period.
2. Jalra M- the medicine which he has given me can bring flatulence or heaviness in my stomach.
Pl advice if that is the case, which other alternative medicine, I should use.
I am also attaching my complete blood report along with this mail. Kindly go through it and advice if I need any further medication, apart from what has already been prescribed.
For follow up, kindly let me know the procedure.
An early reply would be highly appreciated.
Kind Regards
Brief Answer:
Diabetes education.
Detailed Answer:
Hi,
I am trying to clear your doubts keeping it as simple as possible.
1) Inj Novomix contains fixed combination of Short acting and Intermediate
acting insulin.
Short acting insulin helps to control post-prandial blood sugar levels while
Intermediate acting insulin controls fasting and other premeal blood sugar
levels.
Novomix being combination of two in fixed dose one can not change the dose
of either short acting or intermediate acting insulin alone without change in
other.
So in some cases we prefers to use two insulin as separate, only issue with
that it increases the number of injections.
Though educating mixing of two different compatible insulin in a syringe can
overcome the problem.
Long acting insulin instead of intermediate acing insulin has more
advantages.
All this can be explained by demonstration and one to one counselling which
is not possible with this platform.
Better to consult your diabetologist for same.
2) Jalra M (especially metformin component) may be associated with stomach upset in some patients as in your case. But continuous use helps in adaptation of body.
3) After going through your blood test reports-
• HbA1c of 7 is really good for 20 years of diabetes.
• Considering your age, weight, serum creatinin your calculated GFR (Glomerular Filtration Rate) is more than 60 so no problem with use of metformin in full dose as far as kidney is concerned.
GFR denote stage of kidney disease.
• Your LDL cholesterol is quite high I may suggest use tablet containing Atorvastatin 40mg at night along with separate tablet containing Fenofibrate.
• Need increasing the dose of Thyronorm as already suggested.
Other reports are within acceptable range.
In future you can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954
Regards,
Dr. Abhay Mali.
Diabetologist.
Diabetes education.
Detailed Answer:
Hi,
I am trying to clear your doubts keeping it as simple as possible.
1) Inj Novomix contains fixed combination of Short acting and Intermediate
acting insulin.
Short acting insulin helps to control post-prandial blood sugar levels while
Intermediate acting insulin controls fasting and other premeal blood sugar
levels.
Novomix being combination of two in fixed dose one can not change the dose
of either short acting or intermediate acting insulin alone without change in
other.
So in some cases we prefers to use two insulin as separate, only issue with
that it increases the number of injections.
Though educating mixing of two different compatible insulin in a syringe can
overcome the problem.
Long acting insulin instead of intermediate acing insulin has more
advantages.
All this can be explained by demonstration and one to one counselling which
is not possible with this platform.
Better to consult your diabetologist for same.
2) Jalra M (especially metformin component) may be associated with stomach upset in some patients as in your case. But continuous use helps in adaptation of body.
3) After going through your blood test reports-
• HbA1c of 7 is really good for 20 years of diabetes.
• Considering your age, weight, serum creatinin your calculated GFR (Glomerular Filtration Rate) is more than 60 so no problem with use of metformin in full dose as far as kidney is concerned.
GFR denote stage of kidney disease.
• Your LDL cholesterol is quite high I may suggest use tablet containing Atorvastatin 40mg at night along with separate tablet containing Fenofibrate.
• Need increasing the dose of Thyronorm as already suggested.
Other reports are within acceptable range.
In future you can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954
Regards,
Dr. Abhay Mali.
Diabetologist.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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