Patient's Query
Hello doctor,
I am having some weakness issues and pain in my limbs. I have been diabetic for the last five years. My current fasting blood glucose level is 200 mg/dL, and my PP is 278 mg/dL. HbA1c is 8.5 %. Current medicines are Galvus Met 50/1000 twice daily. Diamicron XR 60 two tablets. Pioglit 30 once during dinner. Supradyne once before food.
Thank you.
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.
Patient's Query
Hi doctor,
My current glucose level continues to be at the previous level, as mentioned earlier, with fasting at 188 and pp at 250, even with the above medications, including Dynaglipt m1, as prescribed by you.
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.
Patient's Query
Hi doctor,
I have been taking medicines as per your prescription for the last six weeks. Let me recall my medicines are Diamicron XR 60, 1.5 in the morning, 0.5 at night. Galvus met 50/1000 once in the morning and once at night. Pioglit 15 once at night. Jardiance 10 once after lunch.
My recent fasting glucose level has decreased from 208 to 145-160 mg/dL on average. PP level has reduced from 287 to 170 mg/dL. I am facing some problems with oral infections, this usually happens to me during the winter, but this time, it has been a bit prolonged.
I do not exercise regularly, and I sometimes fail to follow a strictly diabetic diet, but overall, I try to maintain the basic diabetic diet. Another issue that I would like to share is that I am facing some sexual weakness. I am uploading this report as per your instruction to report to you.
I would also request you give me a complete prescription, including my past medicines, which will enable me to order medicines online using this prescription as well from the pharmacy shop.
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.
Preventive measures
Patient's Query
Hi doctor,
I have oral ulcers. Please send me a complete prescription and please suggest me some regular medication for ED that I can use irrespective of having contact.
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.
Patient's Query
Hi doctor,
I am communicating with you as I have noticed some noticeable changes in my body over the last one and a half months or so, which I did not mention earlier. I have been taking Jardiance 10 once after lunch as prescribed by you, with Galvus Met 50/1000 twice and Diamicron XR 60 twice, and Pioglit 15 once. I was having some mouth ulcer problems for which you have prescribed vitamines and Folvite, which I am also taking. My mouth ulcer has decreased a bit. But what I have noticed over the one and half months is that my body weight has been decreasing consistently. My weight hovered around 154.324 lbs earlier, but it has been gradually decreasing over the period, and today morning, it stood at 144.1823 lbs. In fact, for the last seven days, the weight loss has been very rapid. Besides, I am feeling exhausted very easily, particularly in the morning. I am also facing shortness of breath and weakness in the waist and lower portion. There has also been a significant change in my bowel movement; I am facing severe constipation, which I never faced in my life. I am also facing heavy palpitation almost throughout the day. I have tried to increase the protein content in my diet. I have also not done any exercise or any weight-reducing activities during this phase. However, after taking Jardiance, my fasting, and PP blood glucose level has reduced significantly. One thing I wish to mention in this context is that I am a smoker, but I am trying to quit it.
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.
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Answered byDr. Prabhakar Laxman Jathar
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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