Dr. Thiyagarajan. T
Diabetology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 53-year-old female. I have had a complex problem for six years, and I have written out my situation as a whole. I have diabetes, raised D-dimer, high blood calcium due to hyperparathyroidism, osteopenia, arrhythmia, shortness of breath, fatigue, dizziness, diffuse body pain, sleeping difficulty, and foot pain. My current medications are Bisoprolol, Atorvastatin, Aspirin, and Omeprazole. Before two years, I was hospitalized for three weeks because of chest pain, where I was diagnosed with diabetes, osteopenia, high calcium levels, and hyperparathyroidism. I was treated with antibiotics for my H.pyroli infection and was given bone injections that reduced my chest pain.
Now, what should I do?
Kindly help.
Hi,
Welcome to icliniq.com.
From your statement, you have the following issues,
1) Hypertension.
2) Osteopenia.
3) High calcium is possibly due to hyperparathyroidism.
4) Dyslipidemia.
5) Diabetes.
6) History of H.Pylori infection.
And you do not seem to take any medicine for diabetes now.
Now, how can I help you?
Thanks.
Patient's Query
Hi doctor,
Thanks for the reply.
Diabetes is not confirmed. I found it on my old medical record, but the hospital did not tell me. Would you please tell me the tests that I must do to ensure diabetes? Also, help me know what treatments I should take for other medical issues that I have. Will I get osteoporosis if hyperthyroidism is left untreated? I am attaching reports and would like your opinion on the figures. I always feel dizziness that makes me look slightly odd and disabled in front of other people.
Kindly help.
Hi,
Welcome back to icliniq.com.
I have reviewed your laboratory tests reports for the last three years (attachments removed to protect the patient’s identity). From your statement and the laboratory reports, it is evident that you do not have diabetes. You may have primary hyperparathyroidism. Also, I would suggest doing a vitamin D deficiency test first before other tests. Your fatigue and dizziness may be related to vitamin D deficiency. If the deficiency exists, it is advisable to replace it first, with careful monitoring of calcium levels.
I hope this is useful.
Thanks.
Patient's Query
Hi doctor,
Thank you so much for all this information. I am waiting for blood test reports, and it takes a couple of months here. I am sure my doctor will not mind adding your recommendations. I do not use milk and yogurt. I use soya milk in coffee which is cheap, and occasionally fresh cream. I do not have kidney stones. They did a DEXA bone scan. I thought I do not have diabetes, and that report must have been a mistake. I had a painful breastbone that hurts during palpitations, which they fixed with injections into the breast bone. Is this due to osteopenia, and are these medicines to prevent its progress? What medicine did they give me, which is a bitter liquid for high calcium levels? I guess that I had a vitamin D test before two years and the doctors decided not to replace it. Will calcium make parathyroid rise or vice versa? My general practitioner said not to take calcium as it is high. Do you agree?
Kindly give your suggestion.
Hi,
Welcome back to icliniq.com.
Do you have the results of the DEXA (dual-energy x-ray absorptiometry) scan? The pain in the breastbone area may or may not be related to osteopenia. The injections you got in the breastbone area are probably pain killers or local anesthetics, or steroids. Medicines used to prevent bone loss are Alendronate, Risedronate, Ibandronate, Pamidronate, Zoledronic acid, etc. The bitter liquid may be Cinacalcet. It is used to reduce calcium levels. Other reasons for high PTH (parathyroid hormone) are secondary hyperparathyroidism due to vitamin D deficiency, kidney failure, and low calcium intake in the diet. But in all of these conditions, you have low calcium and not high calcium. One rare cause of high PTH with high calcium is a rare genetic condition called familial hypocalciuric hypercalcemia (FHH), where you excrete low amounts of calcium in the urine. This is rare, and no need to treat it most times. If you have low vitamin D, you should get vitamin D with careful monitoring of calcium levels. The role of PTH is to raise calcium when it is low. So, if calcium is high for some reason, PTH should be lower. If it is not, then you likely have primary hyperparathyroidism or FHH.
Thanks.
Patient's Query
Hi doctor,
Thanks for the reply.
My general practitioner relies on specialists, but it takes a long time to see a specialist here, and also I have been having symptoms for a while. They gave me steroids into my breastbone, and they told me I would get the pain back and need another injection in six months, but it never came back. So, I understand I must check vitamin D and take them as tablets if my value is low. I do not have my DEXA scan report. I can get my records on request but, it will take two months. Do you need to see them?
My queries are as follow;
1) Does my high calcium level need treatment?
2) Should I take calcium tablets even if my calcium is high?
3) Do you think it is a cardiac risk?
4) Should I have medicine for osteopenia?
Thank you so much.
Hi,
Welcome back to icliniq.com.
I am not sure if they gave you steroids. You might have received local anesthetics into your breastbone. Yes, If your vitamin D level is low, you should take vitamin D supplements. But when you start taking vitamin D, it is advisable to check calcium level to ensure it does not go too high. I recommend you to get calcium through dietary sources and if not adequate, then go for a supplement. I will attach a calcium table at the end of this conversation. You can use it to find out how much calcium you are getting daily. Yes, high calcium needs treatment. If it is because of primary hyperparathyroidism, you need surgery as the first line of treatment. But if surgery is not possible or not indicated or delayed, you can get medicines like Zoledronic acid to prevent bone loss.
Other medicines like Cinacalcet can also be given if calcium is too high and if you have symptoms. But on the most recent test, your calcium was not increased. And yes, you may get some cardiac risk if your calcium level remains high. If you can, please send the DEXA report when you can get it. Also, if it has been two years since the last DEXA scan, you should repeat it now. If you have more bone loss than the previous scan, that is an indication of getting surgery. Until then, for osteopenia getting calcium and vitamin D adequately, not smoking, having regular exercise, and weight-bearing exercises are recommended. I recommend you take Alendronate or Zoledronic acid if the procedures mentioned above take a very long time to get done where you are.
Calcium table:
The recommended dose of calcium for adults per day is 1200 mg.
Sources of Calcium:
1) Milk (8 ounce) - 300 mg.
2) Yogurt (6 ounce) - 250 mg.
3) Orange juice with calcium (8 ounces) - 300 mg.
4) Tofu with calcium (half cup) - 435 mg
5) Cheese (1 ounce) - 195 to 335 mg.
6) Cottage cheese (half cup) - 130 mg.
7) Ice cream (half cup) - 100 mg.
8) Soy milk (one cup) - 100 mg.
9) Beans (half cup cooked) - 60 to 80 mg.
10) Dark, leafy green vegetables (half cup cooked) - 50 to 135 mg.
11) Almonds (24 whole) - 70 mg.
12) Orange (1 medium) - 60 mg.
Thanks.
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Diabetology
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