I am diabetic and BP patient. I have minor breathing problem for and mild chest pain also. all lab tests reg heart ok. what is the problem?

[arekere]

All lab tests like ECG, Echo cardiagram, TMT, Lab tests like K level, NA level, ok.

[namaha Administrator]

Dear Arekere

Can you please let us know some more info about you so that we could guide you further...

(1) How old are you.?

(2) since when r you diagnosed diabetes?

(3) your Hba1c history ?

(4) Any kind of physical exercise you are doing now ?

(5) what medications r you taking ?

(6)what kind of diet r u taking?

[arekere in reply to namaha]

Age : 60

Diabetic since : 12 years

HBA1C : latest 8.5, Last 5 years 8.0 to 8.8

Exercise: Daily Yoga for 1 hour. Walking 5 to 6 km at 6km/hour speed.-

Medications: Glycomet GP 1 forte( 1-0-1), Trazenta 5 mg (0-1-0), Voligo 0.3 mg(1-1-1)

BP started from last 2 months. taking tazloc 40 mg

Diet : Vegetarian, night mostly Chapathis, morning Dosa, Idli, Lunch: rice , seasonal fruits

[namaha Administrator in reply to arekere]

Sir

I am sorry , I forgot to ask you your Body weight/ BMI ....

After hearing from you, will respond to you with my advice...

Hope you are doing fine...

[arekere in reply to namaha]

My height is 5ft f inches and my weight is 58 kg and my bmi is 21.5

[namaha Administrator in reply to arekere]

Dear arekere

Thanks for providing all the details !

You don't seem to have Covid19.. don't worry ... Unless you have severe symptoms of sore throat , cough, sneezing...

First of all, you need to bring down your blood sugar level Hba1c to 7. and below..

(1) As suggested by other members, You need to reduce Carbohydrate by minimising refined Carbs such as Rice , Idliy and Dosa , chapati as far as possible ! Will suggest you a vegetarian meal plan in my point no 3..

If possible , if you can adopt a post meal exercise plan, it will help you to reduce your blood sugar post meal and bring down your Hba1c...

(2) For your low weight of 58 kg, Glycomet GP1 forte twice daly meaning Metformin dose of 2000 mg per day is extremely high...by any standard... You are already taking Gliptin 5 mg daily....

Metformin 2000 mg is advised for obese/ overweight Type-2's.. you are already thin and you will become still thinner... ...Metformin 2000 gm per day is making you weak .. it may kill your appetite and it will reduce your weight further and make you totally lean and thin. This may be the cause of your breathlessness.

Please do consult another doctor / Endochrinologist from Fortis hospital / Apollo if such a branch is available at your place if required go to your nearest city....

At best , you can have Metformin 500 mg twice daily. All modern Doctors would advise Gliclazide which is more effective than Glimeperide......please do consult a new doctor ....

Even Trajenta 5 mg is Teneligliptin which is a newer drug...why not Vildagliptin or Sitagliptin which are in use for last 10 years.... May be your new Doctor may suggest you Galvusmet 50/500 twice daily .... No other 3rd medicine required....currently you are taking Metformin, Glimeperide and Teneligliptin....

By seeing your body weight and BMI, I guess You may have extremely low level of circulating insulin which you can test in a lab... Fasting insulin and C-Peptide test...

(3) You need to eat Calories such that it meets your daily requirement and does not spike your blood glucose...currently you are eating high GI food and total calories per day is low which is making you weaker... Also your diet seem to have no Fiber.... Fiber from vegetables would help avoiding blood glucose spike ...

Breakfast @ 8-9 AM....

20-30 Lightly roasted almonds..... 1 cup full Fat Home made Curd topped with Soaked chia seeds ( 1 teaspoonful soaked overnight) .... Take 100-150 gm Low GI fruits such as strawberry or Green guava or kiwi or plum or papaya or the imported orange...

You can also have moong sprout mixed with methi sprout..

If you want to have a Dosa, you may eat with a lot of mix veg masala in it... such as cabbage, peas, carrot, beet , grated coconut, tomato, garnished with onion, ginger garlic paste...

Lunch 1PM/ Dinner 7 PM :

Take food sequentially as follows....

1 cup home made tomato soup or mix veg soup topped with 2 tsf Soaked chia seed...

Then take 1 bowl green salad.. 200 gm of cucumber, carrot, cherry tomato ....

....then 1 bowl of Mix sprout of Moong and Methi approx 100 gm...top up with grated coconut 50 GM's and roasted peanuts 50gms...

Avoid Grains as far as possible.... If you want for a change you can have a stuffed Parotha ( whole wheat) - stuffed with a lot of cabbage / grated coconut/ cauliflower/ carrot / beet, onion garlic ginger.

You can also stuff with full fat panner in stead of grated coconut ...

1 cup Rajma or any dal you can have.. along with any vegetarian curry...as per your taste...

Avoid potato, Aravi, Rice, wheat as far as possible ...sugar, sweet, high GI fruit such as mango, banana, chikoo....

Please remember 1 gm fat gives you 9 Calori and 1 gm protein / carbs will give you 4 caloris. There are Apps available. Aim to eat at least 1500 Calori per day.

Physical exercise : Already , you are doing it. If you plan it post meal , it will be helpful to you to keep your sugar under control... I would strongly recommend to buy a treadmill for your use.... Invest this for your health ... it is worth it ...

Ensure sound sleep of 7-8 hours daily .....if you are not having sound sleep.... Please don't hesitate to contact me.....please go to bed at 10.30 pm and get up at 5-6 AM.. first do some stretching exercise / yoga whatever you can do... Do some Pranayam ... Deep breathing exercise ... practice and gradually increse duration ......Kapalbhati, alternate nostril breathing , bhastrika....

Buy a Glucometer at home to see how your blood glucose responds to the diet you eat....

(4) Supplement :

Check your vitamin D level.. if you are deficient ... Consult a your doctor to take 60k units once a week for 8 weeks...

Even if no deficiency, you can still take to enhance your Immunity...

Vitamin D 2000 iu per day...

Vitamin C- 500 mg per day

Zn acetate-30-50 mg per day

B12... If you are deficient 1500mcg per day methylcobalamine.

Stay Safe , Stay healthy ...

[arekere in reply to namaha]

Thanks a lot sir for your detailed answer. i will update you the progress.

[namaha Administrator in reply to arekere]

When you go to see your Endochrinologist.....tell him that you don't want to lose weight.... As you are already thin...and so he should reduce your Metformin...

Also please remember:

There are two kinds of medications :

Insulin sensitiser : Metformin , Pioglitazone which helps in proper utilisation of insulin by body... Metformin tend to reduce body wright if taken in heavy doses and Pioglitazone tend to increase weight little...

Insulin secretagogues: Sulphonylurea such as Glimeperide, Gliclazide, Gliptins such as vilda Gliptin, Sitagliptin , Teneligliptin etc helps to produce insulin by pancreas....

If you have sub-optimal /very low level of insulin which normally happens with thin built body...which you can confirm by blood test...

But normally any doctor gives a combo drug of Insulin sensitiser plus insulin secretagogues to every one...

In fact, obese type 2, has excess insulin in the blood ... but their body is not able to use the insulin properly...so an obese type 2 need not be given insulin secretagogues....he can manage his blood sugar by fasting /exercise /keto or a low carb diet and at best an insulin sensitiser....

But a thin type 2 needs both...if he is not able to control his blood sugar by diet and exercise .. because he has extremely low level of insulin .... Insulin is a master hormone... Whatever he eats whether fat or protein or carb, finally insulin is required for food metabolism..

If you have any specific doubt, please do ask for clarification...

[ramana42 Volunteer]

Are you from Bengaluru?Your problem may be due to polluted air because of heavy traffic added to moist rainy conditions.

[barani19 Administrator]

arekere ,

Your HbA1c seems to be a bit high.

Please do Covid19 test. You might be asymptomatic.

[makarim]

Sir,your HbA1c is high.your food contains lot of carb.Reduce carb from diet.Reduce excess salt. Avoid stress and do not think too much on diabetes.Have a sound sleep .If you reduce carb gradually and monitor your glucose level through glucose meter after food and do a log of what and quantity of food you are taking and its effect on glucometer you can know your self.Now regarding Corona test ,you can go for a test .Go and meet some good diabetologist.But in my opinion ,if you take minimum carb and continue your walking your HbA1c will be with in 6.5 .Hope to see you recovering soon.

[arekere]

Thanks for reply. My fasting glucose level will be alwas less than 170 and after food less than 220. hope to improve to change. My breathing problem is from 2 months. so it may not be from corona.

[sandybrown]

Any change in your home or working environment?

[arekere in reply to sandybrown]

NO. My walking was reduced to terrace walking during april and again in july. Yoga as usual

[sandybrown in reply to arekere]

Is it a tow story building or higher level building? Dust on the trace or plants on the terrace?

Berating difficulties, fumes from traffic on the road?

Try wearing a mask while walking on the terrace!