My sugar levels are high along with painful weak limbs. What to do?

Hello,

Welcome to icliniq.com.

I have seen the details given, including the laboratory reports (attachment removed to protect patient identity). Your blood glucose (both fasting and PP) are high. Fasting is particularly much higher. HbA1c % is also fairly high, both suggesting improper control of diabetes. This itself can be the cause of weakness. Ideally, in well-controlled diabetes, fasting glucose should be <100 milligrams, PP 150 to 160 milligrams, and HbA1c % < 6.8. Therefore, looking at this situation, there is a need for upgrading the treatment with some additional drugs, plus there has to be a closer look given to your diet and exercise schedule. So, I would like to know your diet pattern and the extent of daily exercise being done. I suggest the addition of tablet Teneligliptin 20 milligrams plus Metformin daily once just after lunch. I am enclosing the prescription.

Thank you.

Hello,

Welcome back to icliniq.com.

I have seen the details mentioned. In fact, after writing my answer last time, I wrote another note, telling you not to use Dynaglipt as you were already on Vildagliptin.

In the current situation, there is a need to upgrade the treatment, either with an SGLT-2 inhibitor (Jardiance 10 milligrams, containing Empagliflozin) or Insulin Injections. To begin with, you may start with tablet Jardiance 10 milligrams once a day after lunch, then let us check blood glucose after ten days (both fasting and PP) to see the effect. With that tablet, certain precautions are needed- Clean the tip of the penis and glans by retracting the foreskin to remove any glucose molecule that may remain there. This is essential for preventing any post-treatment problems.

I am enclosing a prescription for the same.

Plus, please let me know your diet and extent of daily physical activity, particularly exercise being done. Because in glucose control, diet, and exercise play a greater role. If you have any doubts, please do come back.

Thank you.

Hello,

Welcome to icliniq.com.

Looking at your fasting and PP glucose levels (attachments removed for patients' identity protection), there is a clear sign of improvement in diabetes control. It is good to know that. However, please clarify what you mean by oral infections. Do you have difficulty swallowing, throat irritation, or a change in voice? Or is there glossitis, stomatitis, and ulceration in the mouth? These problems lead to difficulty in eating even slightly spicy food. If the oral infection is there, that may lead to even coughing. So please do clarify.

As regards the problem of erectile difficulty (ED), which is a common complication associated with diabetes, small blood vessels(microvasculature) supplying penile muscles are affected. This needs strict glucose control, plus you may also need a drug like Sildenafil tablet, 25 to 50 milligrams, to be taken just before the expected contact. The tablet should be used as and when required. There are many brands available, the well-known name being Tablet Viagra 50 milligrams. I await your explanation regarding oral infections.

Thank you.

Hello,

Welcome back to icliniq.com.

As already explained, erectile dysfunction in a diabetic person is a consequence of microvasculature damage. The damage is invariably irreversible. So the usual treatment is to help erection as and when needed. That is just a time when contact is expected. The PDE IV inhibitors group of drugs helps in this. Sildenafil is one of those. There is no other drug that can help (other than this group mentioned earlier). I hope I have made it clear. Even achieving strict glucose control from now on is not likely to reverse the condition.

For treating mouth ulcers, you may take Capsule Cobadex Forte daily and Tablet Folvite 1 daily for about ten days. I am enclosing the prescription.

Thank you.

Hi,

Welcome to icliniq.com.

The main reason for feeling weak is uncontrolled diabetes. It is necessary to achieve strict glucose control by fasting closer to 100 milligrams or < 100 milligrams, PP 160 to 170 milligrams, and HbA1c% <6.8. This is possible only by using all the drugs that you are using, including Jardiance tablets. Jardiance does help in reducing extra weight as it increases glucose excretion through urine. (That is its mechanism of action). As regards muscle pain and pain in limbs, that happens because of not exercising regularly. Once diabetes is controlled, strictly majority of symptoms will be in control. In addition to the present medication, please take Vitamin D3 powder or chewable tablets and Capsule Mego - XL, which will help in controlling other symptoms and weakness. But strict glucose control is the only main requirement. Please avoid alcohol and smoking. I am enclosing a prescription for the above-mentioned medicines.

Thank you.