What is the treatment for chronic gastric issues in a diabetic patient?

Question

Hello doctor,

I am 58 years old and weigh about 187 lbs. I am an Insulin-dependent diabetic patient. I have had diabetes for the last 20 years and insulin-dependent for the last ten years. I take 1000 mg of Metformin after breakfast and dinner. I take Linagliptin 5 mg and Trinexovas 20 mg in the morning. I take Rosuvastatin 10 mg, Finofibrate 145 mg, and Asprin 75 mg at night. As my mind wanders at night, I take 0.25 mg of Trika as self-medication. I take 30 IU Glulisine and Glargine each morning and night with occasional shots of Glulisine whenever I feel my sugar count is high.

Recently, I had a lot of indigestion problems, so I was given some prebiotics and probiotics, which gave me some relief. But it started again after it was stopped subsequently, and I have prescribed Domperidone, but I am taking Acidic 300 mg, and PAN D added to it as self-medication. Today I had many problems with my stomach due to gas and indigestion. I felt (I repeat, I felt) that I was either unable to flow urine or urine was not getting generated. I was worried about my kidney because I am an alcoholic on weekends (six pegs with soda and water).

I went to my pathologist to get my blood tested and the reading given were: HbA1c - 7.5, random sugar - 175 mg/dL, SGOT- 49 U/L, SGPT- 37 U/L, total bilirubin - 0.71 mg/dL, direct bilirubin - 0.38 mg/dL, blood urea - 21 mg/dL, and serum creatine - 1.1 mg/dL. I have a continuous sitting job, and I carry work home. I am a workaholic and alcoholic and do not do any exercise too. Being an alcoholic, what tests should I take as a follow-up for high SGOT? What is the treatment for my stomach condition with constant indigestion and gas?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

I have reviewed your case history in detail. Your issues, as per your history and laboratory investigations, are :

1. Uncontrolled diabetes.

2. Elevated SGOT (serum glutamic-oxaloacetic transaminase) likely alcohol induced.

3. Indigestion (possible reasons; alcohol-induced gastritis, diabetes mellitus-induced gastroparesis, Helicobactor pylori stomach infection, small intestine bacterial overgrowth considering not good control of diabetes and your lifestyle).

4. Anxiety.

5. Not sure about your urinary complaints.

For the conditions mentioned above, I suggest the following.

1. You must be more careful regarding your diabetes; HbA1c (glycated hemoglobin) should be around 6 or 6.5.

2. Recheck liver function tests after four weeks.

3. Continue PAN-D tablet (Pantoprazole and Domperidone) half an hour before breakfast; it already has Domperidone, so there is no need to take it separately until and unless nausea or reduced appetite in the evening. Aciloc (Ranitidine) 300 mg is not a drug of choice these days.

4. Get your H. pylori stool antigen test to rule out stomach infection.

5. Continue probiotics daily. It is safe to have probiotics daily.

6. I agree with your medicine at night, which is a relatively low dose and helps you out regarding your sleep and anxiety.

7. Kindly get your detailed urine report regarding your urinary symptoms.

Thank you.