H/o profuse sweating Dear dr Golam Murtuza specifically at what time he is sweating My concern is during night or early morning I suspect hypoglycaemia Hence guide him to test random sugar during episode also go deep in symptoms of hypoglycaemia Pt is long standing diabetic hence investigate for DKD Also consider obesity and overweight Look for any metabolic disorder
His sugar is well controlled for DM. He may be going in for hypoglycemia or may be due to autonomic nuropathy due to DM. His echo is normal. Diastolic dysfunction grade 1 is normal for his age. Autonomic nuropathy is difficult to treat even if you control the blood sugar well.
Betablocker is not Diabetogenic, rather it MASKS the Hypoglycemic Symptoms. So, Hypoglycemic diagnosis is delayed. Anxiolytic, U can use Tablet Clonazepam 0.25mg initially TDS & after 7 days in BD doses. Increase it to 0.5mg at night, if adequate sleep is not ensured. Propranolol in low doses like 10mg BD are quite safe, to reduce sweating & tremors. But then also do Monitoring of Blood Sugar on daily basis, or as frequently as possible.
SUGGESTIVE. OF... HYPERHIDROSIS SECONDARY. TO.... PEREPHERAL NEUROPATHY AND METFORMIN. INDUCED.. .. ..PEREPHERAL. NEUROPATHY.... IN. D. M.....IS. USUALLY ....SECONDARY. TO DEFICIENCIES. OF VIT. B. COMPLEX VIT. D AND SERUM. ELECTROLYTES' IMBALANCE..
Suspected hypoglycemia, readjust the doses of antidiabetic drugs. Get RBS when the episode is there and treat accordingly.
Sweating is most common & natural phenomena during hypoglycemia & frontal sweating common during eating. Patient has past MI but this ECG is in WNL Cardiac symptoms are silent in long standing diabetes. So you should have to go for Angiography 100 % for any blockage
Suspected hypoglycaemia, dose to be revised
@Dr. Golam Mortuza Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorder. Rule out Thyroid Problems Most probably Anxiety releated
Differential Hypoglycemia Anxiety
Ecg /Echo is non significant Ruled out Hypoglycemic eoisode
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DIABETIC NEUROPATHIES. Diabetic neuropathies are a family of nerve disorders caused by diabetes. WHAT CAUSES DIABETIC NEUROPATHY. Nerve damage is likely due to a combination of factors. 1.METABOLIC FACTORS. : hyperglycemia, long duration of diabetes, abnormal blood fat levels and low levels of insulin. 2.NEUROVASCULAR FACTORS : Neurovascular factors leading to damage of blood vessels that carry oxygen and nutrients to nerves. 3.AUTOIMMUNE FACTORS : Causes inflammation of nerves. 4.MECHANICAL FACTORS : Injury to nerves as in carpel tunnel syndrome. 5.INHERITED TRAITS : That increase susceptibility to nerve disease. 6.LIFESTYLE FACTORS : Smoking, alcohol. SYMPTOMS. Symptoms depends on the type of neuropathy and which nerves are affected.Symptoms involve sensory,motor and autonomic nervous system. 1.Tingling, numbness or pain in the toes,feet,legs,hands,arms and fingers. 2.Wasting of muscles of hand or feet. 3.Indigestion, nausea, vomiting, diarrhea,c constipation. 4. 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