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Q. After getting diagnosed with diabetes, my father feels anxious with breathing difficulty. Why?

Answered by
Dr. Aleph
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 23, 2020 and last reviewed on: Jun 03, 2020

Hi doctor,

This is for my dad, and we found out that he has diabetes. He became very worried which makes him difficult to breathe and cannot get enough sleep and rest at night.

He had stomachache and he used to skip meals, and drink coffee and soft drinks. After a blood test, we found that he has diabetes. I cannot get enough sleep, and worried. He always feels tired and anxious with breathing difficulty especially if alone. He is currently taking Metformin and Omeprazole.

#

Hello,

Welcome to icliniq.com.

Perhaps your father has misperceptions about the disease and that is causing his anxieties and worries. It is unfortunate he developed but it does not mean it is the end for him. As long as he takes his medications, does his routine laboratory workups and checks with his physician then there is nothing much to worry about.

He must be informed that as long as he consults with his physician regularly then there will always be an expert making sure he is doing alright and making sure that no complications will develop because of the disease.

If the pandemic is causing more worries, it is normal. He might be aware that his condition puts him at a disadvantage compared to a normal healthy individual. But as long as he adheres to social distancing, proper handwashing techniques, precautionary measures such as wearing masks and PPEs (personal protective equipment), if needed, then there is a low risk he might acquire the disease. Remember, diabetes and COVID-19 both are preventable diseases. He needs to take care of himself properly and to do this is by following his doctor's orders and guidelines during the pandemic.

However, I am worried about the declared respiratory rate of 86 (normal is at 18-22). Does he smoke? Any cough or colds? Previous hospitalizations? At this rate, it is best to bring him to the ER for further evaluation. When counting for the respiratory rate it is the one cycle of the rise and fall of the chest. So 1 respiratory rate is equivalent to 1 rise and 1 fall of the chest.

Thank you doctor,

The rate was a mistake, we counted the heartbeat per minute and we found that it is normal. Any other recommendations or foods for diabetes?

#

Hi,

Welcome back to icliniq.com.

A diabetic diet would mean less sugar and carbohydrates. He needs to have a well-balanced meal wherein half of his plate should consist of high fiber (fruits - avoid sweets - and vegetables). The other half should be divided into protein and one cup of rice per meal. He may have snacks in between meals (should be high fiber). Avoid sugary drinks. If he drinks coffee, it should be no sugar or he may add sugar substitutes such as Splenda or Stevia.

Ideally we suggest rice, brown rice, or whole-grain/wheat. He needs to take fish at least twice a week because these are rich in omega. Good oils will include canola, and olive. If he likes bread he can take whole wheat bread.

Things to avoid:

1. High-fat dairy products.

2. Avoid fatty food such as bacon, sausage.

3. Avoid processed snacks and baked goods.

4. Avoid eating egg yolks.

5. Less sodium intake.

Thank you doctor,

I have another query. Is it normal to have excessive sweating? My aunt and cousin are also experiencing the same and wakes up in the middle of the night because of sweating. Also, we managed to get a glucometer and tested it. It was 105 mg/dl. Metformin is still taken after lunch and Omeprazole for ulcer. Shall we now take foods with sugar to increase sugar levesl? Is that the cause of excessive sweating?

This is the reference guide included in the glucometer (20-69 mg/dL - low, 180-239 mg/dL - high and 240-600 mg/dL too high). May we also ask for recommended foods and drinks.

#

Hello,

Welcome back to icliniq.com.

For patients with diabetes, CBG (capillary blood glucose) monitoring should be 70-130 mg/dL before meals or after meals it should be less than <180 mg/dL. His CBG result is well within normal limits, which is good. He should continue his maintenance medication as instructed by his physician to monitor his sugar control more accurately.

As much as possible, he should limit his intake of sweetened foods. In general, foods containing high carbohydrates can also affect his sugar level and not sugar alone. That is why we advise diabetic patients to have low sugar, low carbs, high fiber, and high protein diet.

The excessive sweating, perhaps it is related to the warm weather? Usually in our sleep when our body is in a state of REM (deep sleep, rapid eye movement, where most dreams happen) the metabolic activities in our bodies are high and may result in increased sweating. Otherwise, if you have symptoms of sleep disturbances, easy fatigability, unexplained weight loss, hair loss, dry skin, changes in menstrual period, and irritability. It might be best to check for the levels of thyroid hormones such as TSH (thyroid-stimulating hormone), FT4, FT3.

His diet should include low fat, low carbs, high fiber, and high protein meals. So more on vegetables, fruits, whole grains, eat less potatoes, whole wheat bread or pasta, brown rice, fish, and dairy products (low fat). He should avoid sweetened beverages including fruit shakes/juices, avoid red meat and fast foods. If he drinks coffee it should be plain. If he needs a sweetener, he may add non-nutritive sweeteners like Stevia or Splenda these will not result in an increase in sugar.

Thank you doctor,

We tested the meter yesterday and it was 102 mg/dl. Today, it was 105 mg/dL in the morning, before breakfast. We just tested again to check his blood sugar 1 hour after lunch and it is the same, 105 mg/dl. Also, he lost a lot of weight these past few days, thinking of things too much causing stress. He is still taking Metformin every day after lunch (for three months).

Also, he was advised to take Omeprazole in the morning before breakfast and before bed for two weeks, but Omeprazole in the morning is causing him difficulty in breathing. But at night, it is fine. Can we just take it at night until Omeprazole medicines are finished?

Also, can we start to take the MX3 supplement again? (He has been taking MX3 for almost a year and did not experience any migraine attacks since). Can we take other vitamins aside from MX3? Can we take B-complex or any vitamins?

#

Hi,

Welcome back to icliniq.com.

No need to do routine CBG monitoring since he is not on insulin therapy and it seems he is responding to Metformin. A once a day CBG monitoring before or after meals will suffice. Just be sure to take note when it was taken, before or after meals.

The Omeprazole was given for hyperacidity or burning epigastric or abdominal pain? Ideally, the drug should be taken in the morning 30 minutes before breakfast doing otherwise will make the drug ineffective. If he is not experiencing any symptoms relating to hyperacidity or dyspepsia he may discontinue the said drug.

He may take MX3, there is no harm to it unless he has problems with his kidneys or liver. Any vitamins will suffice as long as there is vitamin B included will help with the tingling and numbing sensation of the hands and feet.

He probably lost a lot of weight because of his diabetes. This is because, prior to initiating Metformin, his body was having difficulty utilizing or using glucose (sugar) hence in order to meet the metabolic demands, his body was using up his fats and protein sources. That is why unexplained weight loss is also a symptom of diabetes.

There is no absolute restriction when it comes to his diet. We do not want to deprive him of his favorite foods because that may lead to depression. Just be sure that he eats a well balanced meal and avoids sugary or sweetened foods. He may have a cheat day, but moderate consumption.

In a few weeks or so, you will eventually note improvement in his body weight (monitor his weight once a week) and symptoms. This will mean his sugar level is more under control. Try to address his fears and concerns about his condition. At this stage, I believe your father is lucky to have caught the disease early on. Were any lab tests done to check his liver, kidneys, etc? Urinalysis, creatine, and liver profile? If yes, and results were in normal limits then that is really good.

As long as he takes his medications and follows his physician's advice, there is really nothing to worry about. It may take some time for him to get used to things, especially with his diet. But with discipline and perseverance to make himself better, having diabetes will not limit his capacity to do things he used to do or currently doing.

hi Doc,
Sorry again to disturb you. I just want to ask again if dizziness (pagkahilo) and sweating are side effects from taking metformin?
Aside from that, appetite for food increased compared last time. He is also taking snacks in between meals and if feeling hungry (we always have oatmeal no sugar, banana etc.)
Blood sugar is also monitored especially after taking metformin.
(We tried last time where in his blood sugar in the morning was 88mg/dl and we were advised to take sugar (water+sugar) and sugar went to 153mg/dl before lunch, and after 2 hours (lunch) with metformin, it dropped to 79mg/dl and 92mg/dl at night.)
Since we already have the glucometer at home and can monitor the blood sugar, is it possible to stop the medication for 2-3 days? (we only take metformin once a day, after lunch). Does the medicine causes dizziness and sweating in the middle of the night? (also, we have water+sugar at night so anytime we wake up due to sweating, we have water+sugar to replace the energy and seemed that it worked and has energy in the morning compared to only drinking plain water).
Thank you again Doc.
# Have you tried taking his cbg whenever he feels dizzy or sweating? It might be symptoms of hypoglycemia (low sugar) which is a not common side effect of metformin along with dizziness. His cbg monitorings are either borderline low or normal.

How many mg of metformin does he take? How was he diagnosed with diabetes? What were his lab results?

It's good he's eating more, it will help increase his weight as long as those are appropriate for him.
HI Doc, thank you again for your prompt response. Please see attached record. Shall we increase sugar intake then if we feel dizzy?
We had a blood test and said that we have diabetis. Xray and ecg are all normal. We were advised to take metformin once a day, after meal for 30 days., 500 mg (started last May 14).
Does this mean taking metformin is burning all the sugar we take from foods?
Since we started drinking the water+sugar every night and everytime we need to change shirts in the middle of the night, we feel a little better in the morning. (also doc, how to remove the name of the patient? can we remove it and make this confidential)
Thank you again.
# iCliniq is HIPAAA compliant which means it passed the data privacy requirements, so no need to worry about confidentiality issues. Anything we talk about or the files you will share will be kept in this system securely.

I need to know what was the blood test and its result. What was the reason for the initial checkup, was it due to weight loss?

Try to reduce his Metformin 500mg to 1/2 tab once a day. You may monitor his blood sugar levels twice a day pre and post meals. Check his CBG, as needed, if he feels dizzy, light headed, increased sweating, drowsy, weak or lethargic, cold and clammy and if it is below 70 mg/dL you may give him sugar and repeat the CBG test after 10 mins.

With regards to this consultation you may email me at doctoralifecaremedicalclinic@gmail.com but if you are not comfortable you may consult me here but I think you will be charged. It does not allow a free 2nd follow up query.

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