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.
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
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..
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.
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
@Dr. Golam Mortuza Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorder. Rule out Thyroid Problems Most probably Anxiety releated
Suspected hypoglycemia, readjust the doses of antidiabetic drugs. Get RBS when the episode is there and treat accordingly.
Suspected hypoglycaemia, dose to be revised
Differential Hypoglycemia Anxiety
Sinus rhythm LBBB with MI
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A 45 year old female presented with this non healing wound due to toe-ring over second toe anterior aspect of left foot for past 10days. She has been getting injection cefotaxim twice daily from another practitioner. She is a known case of T2DM. Weight - 55 kg Height - 165cm BMI - 20.22 Her present RBS is 260mg/DL I have asked her to get HBA1C, FBS AND PPBS, which I will update soon. Meanwhile sir what antibiotics, OHA and topical application would be best suitable for such patient. @Sepuri Krishna Mohan Sir, I need your valuable advise too.Dr. Ajeet Singh2 Likes25 Answers
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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. Dizziness or fainting due to a drop in blood pressure after standing or sitting up. 5.Problems with urination. 6.Erectile dysfunction. 7.Weakness. TYPES OF NEUROPATHY. Diabetic neuropathy can be classified as 1.Peripheral neuropathy. 2.Autonomic neuropathy. 3.Proximal neuropathy. 4.Focal neuropathy. PERIPHERAL NEUROPATHY. Peripheral neuropathy,also called distal symmetric neuropathy or sensorimotor neuropathy ,is nerve damage in arms and legs.Symptoms are *Numbness or insensitivity to pain or temperature. *A tingling,burning or prickling sensation. *Sharp pains or cramps. *Extreme Sensitivity to touch. *Loss of balance and coordination. Peripheral neuropathy also causes muscle weakness and loss of refle guyxes.Blisters and sites may appear on the numb areas of the foot because pressure or injury goes unnoticed.I f an infection occurs and is not treated promptly,the infection may spread to the bone and the foot may need amputation.Many amputations can be prevented if minor problems are treated in time. AUTONOMIC NEUROPATHY. Autonomic neuropathy affects the nerves that control the heart,blood pressure and blood glucose levels.Autonomic neuropathy also affects internal organs causing problems with digestion,respiration. urination,sexual response and vision. 1.HYPOGLYCEMIA UNAWARENESS. Normally,symptoms such as shakiness,sweating and palpitations occurs when the blood glucose levels drop below <<70 mg/dl.In people with autonomic neuropathy,symptoms may not occur making hypoglycemia to be recognized. 2.HEART & BLOOD VESSELS. Damage to the nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate. Due to this,blood pressuremay drop sharply after standing or sitting,causing a person to feel light headed or faint. Damage to nerves that control heart rate makes the heart rate to stay high , instead of rising and falling in response to normal body functions and physical activity. 3.DIGESTIVE SYSTEM. Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty slowly,a condition called GASTROPARESIS. Gastroparesis can lead to persistent nausea and vomiting,bloating and loss of appetite. Gastroparesis also makes blood glucose levels to fluctuate widely ,due to abnormal food digestion. Nerve damage to the OESOPHAGUS MAKES SWALLOWING DIFFICULT. Nerve damage to bowels can cause constipation alternating with uncontrolled diarrhea, 3.URINARY TRACT & SEX ORGANS. Autonomic neuropathy often affects the organs that control urination and sexual functions. Nerve damage can prevent the bladder from emptying completely , allowing the bacteria to grow in bladder and kidneys causing urinary tract infections. When the nerves of the bladder are damaged,urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine. Autonomic neuropathy also leads to decreased sexual response in men and women. A man may have erectile dysfunction or may reach sexual climax without ejaculating normally. A woman may have difficulty in arousal,lubrication or orgasm. 5.SWEAT GLANDS. Nerve damage may cause improper working of sweat glands.It can also result in profuse sweating at night or while eating. 6.EYES. Due to autonomic neuropathy,pupils become less responsive to changes in light.A s a result,a person may not be able to see well when light is turned on In a dark room or have trouble driving at night. PROXIMAL NEUROPATHY. Proximal neuropathy//lumbosacral plexus neuropathy //femoral neuropathy //diabetic amyotrophy causes pain in the thighs,buttocks,hips or legs,usually on one side of the body. FOCAL NEUROPATHY. Focal neuropathy appears suddenly and affects specific nerves,most often in the head,torso or leg. Focal neuropathy is painful and unpredictable.and occurs most often in older adults with diabetes. However,it tends to improve itself over weeks or months and does not cause long term damage. Focal neuropathy can cause *Inability to focus the eye. *Diplopia. *Aching behind the eye. *Bell's palsy. *Severe pain in the lower back and pelvis. *Pain in the front of the thigh. *Pain in the chest and stomach. *Pain on the outside of the shin or inside of the foot. *Chest pain and abdominal pain is mistaken for heart attack or appendicitis. CAN DIABETIC NEUROPATHIES BE PREVENTED. THE BEST WAY TO PREVENT NEUROPATHY IS TO KEEP BLOOD GLUCOSE LEVELS AS CLOSE TO THE NORMAL RANGE AS POSSIBLE.MAINTAINING SAFE BLOOD GLUCOSE LEVELS PROTECTS NERVES THROUGH OUT THE BODY.Dr. Suvarchala Pratap16 Likes23 Answers
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Know your Vegetables and Fruits Beetroot: Health Benefits, Nutritional Information Beetroot, also known simply as the beet, has been gaining in popularity as a new super food due to recent studies claiming that beets and beetroot juice can improve athletic performance, lower blood pressure and increase blood flow. New products incorporating this highly nutritious food are sprouting up everywhere, especially in juices and drinks. Beetroot, or table beets, although from the same family as sugar beets (beta vulgaris), are genetically and nutritionally different. Sugar beets are white in color and commonly used for sugar extraction and sweetening manufactured foods.Dr. M V Subramanyam7 Likes13 Answers
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A 54 years old male with known history of T2 DM, poorly controlled, comes in complaints of pain over the left foot since one month. On his previous visit it was noted that he has severe diabetic neuropathy. HbA1c- 8.9 %. ESR 78. Uric acid 6.7. Creatine 1.9. X ray foot shows classical findings. Diagnosis and management ?Dr. Mohammed Parvez2 Likes12 Answers
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Friends today I am discussing about Hyperglycemia, Diabetes. TYPE 2 DIABETES SYMPTOMS According to the American Diabetes Association, in patients with type 2 diabetes, hyperglycemia (high blood glucose) typically develops gradually and, at earlier stages, is often not severe enough for you to notice any classic symptoms. This may be why many people are undiagnosed for many years, but being able to recognize the symptoms of high blood sugar can help you to diagnose diabetes, manage it better, and prevent an emergency. For those people already diagnosed with diabetes, having a blood sugar that is sporadically higher than usual doesn't necessarily put you in immediate danger. However, chronically elevated blood sugar may be problematic. Over time, blood sugar levels that are too high can affect the small and big vessels of the body, leading to complications of the eyes, heart, kidneys, and feet. hyperglycemia symptoms Frequent Symptoms Experiencing common hyperglycemia symptoms may be a diabetes warning sign for those who have not yet been diagnosed. If you know you have diabetes, noting these symptoms may be an indication that a tweak in your treatment plan is needed. Excessive Thirst (Polydipsia) In an effort to restore blood sugar balance, your body tries to get rid of excess sugar through urine. As a result, the kidneys are forced to work overtime absorbing excess sugar. But, because they are unable to keep up with the glucose load, they pull fluids from your tissues along with the excess sugar. The more fluid you lose, the stronger your urge is to drink. If you find that you can continuously drink and not feel as though your thirst is quenched, or that you have a severely dry mouth, this may be a sign of hyperglycemia. Increased Hunger (Polyphagia) Excess sugar in your bloodstream means that your body is unable to utilize it for fuel. Hence, your cells become starved for energy and you feel extra hungry and, in extreme cases, unsatiable. But the more carbohydrates you consume, the higher the blood sugars rise. Increased Urination (Polyuria) More frequent trips to the bathroom, especially at night, can be a sign of high blood sugar. This is a result of the kidneys drawing extra water out of your tissues to dilute the extra sugar in your blood and get rid of it through the urine. Blurry Vision High sugar levels force the body to pull fluid from your tissues, including the lenses of your eyes, which can affect your ability to focus and result in blurry vision. Fatigue When sugar remains in the blood as opposed to being taken to the cells for energy, your cells become starved of food, leaving you to feel sluggish or fatigued. This can commonly happen after you've eaten a meal, particularly one that is rich in carbohydrates. Severe Symptoms These particular symptoms tend to occur when someone has had hyperglycemia for a long time, or when the blood sugar is extremely elevated. They usually indicate an emergency. Stomach Pain Chronic hyperglycemia can result in nerve damage to the stomach (gastroparesis). Stomach pain can also be a sign of diabetic ketoacidosis, a medical emergency that needs to be treated right away. Weight Loss Unintentional weight loss is an important sign, particularly in kids who are drinking and urinating often, that the blood sugars are elevated. Many children who are diagnosed with type 1 diabetes lose weight prior to diagnosis. This usually occurs because the body is not able to use the sugar in the bloodstream for fuel. Mouth and Breathing Changes Nausea, vomiting, fruity breath, deep and rapid breathing, and loss of consciousness are indications that you need to seek emergency help. These symptoms can be warning signs of other diabetes-related conditions that can result in death if not treated immediately. Rare Symptoms Some more rare symptoms can occur in people with hyperglycemia, too. Numbness Nerve damage in the extremities (known as peripheral neuropathy) occurs over time and can present as numbness, tingling, or pain in the hands, feet, or legs. Skin Conditions Dry/itchy skin, wounds or cuts that are slow to heal, and acanthosis nigricans (thick, velvety patches found in the folds or creases of areas like the neck, indicative of insulin resistance) can be an indication of hyperglycemia. Frequent Yeast Infections and Erectile Dysfunction These are manifestations that affect women and men, respectively. Hyperglycemic Hyperosmolar Nonketotic Syndrome Hyperglycemic hyperosmolar nonketotic coma (HHNKC) is an extremely serious complication which can happen in those with type 1 or type 2 diabetes, but most often occurs in those who are non-insulin dependent (type 2 diabetes). HHNKC is characterized by a dangerously high blood sugar that is over 600 mg/dL and is typically brought on either by an infection such as pneumonia, a urinary tract infection, or inability to effectively manage your blood sugar. If left untreated, it can result in coma and even death. Signs and symptoms include: extreme thirst confusion fever (usually over 101 degrees Fahrenheit) weakness or paralysis on one side of the body The best way to prevent HHNKC is to take your medications as directed and to keep in contact with your healthcare team when your blood sugar is consistently over 300 mg/dL. Diabetic Ketoacidosis Hyperglycemia can lead to another very dangerous condition referred to as diabetic ketoacidosis (DKA), which occurs most commonly in people who have type 1 diabetes and is often the condition that leads to the diagnosis of type 1 diabetes. DKA is caused when the body has little or no insulin to use and, as a result, blood sugars rise to dangerous levels and the blood becomes acidic. Cell damage can occur and if it continues to progress, it can cause coma or death. DKA needs immediate medical intervention—patients with DKA will need to be monitored by a medical professional and given intravenous fluids, electrolytes, and insulin. Complications Frequent and long-standing hyperglycemia can lead to a host of complications known as micro (small) and macro (large) vascular issues. They include damage to the: eye (retinopathy) kidney (nephropathy) peripheral and autonomic neuropathy (nerve loss in the feet and other areas of the body such as the intestine) Additionally, chronically elevated blood sugars can cause or exacerbate heart disease and peripheral arterial disease. During Pregnancy Hyperglycemia in pregnancy can be particularly damaging to the fetus and the mother. According to the American Diabetes Association, uncontrolled diabetes in pregnancy can pose risks such as spontaneous abortion, fetal anomalies, preeclampsia (uncontrolled blood pressure in mother), fetal demise, macrosomia (large baby), hypoglycemia in babies at birth, and neonatal hyperbilirubinemia, among others. In addition, diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life. In Children Hyperglycemia in children, especially when undiagnosed, can lead to the development of type 2 diabetes or ketoacidosis in those children who have type 1 diabetes. Those children with diabetes who have chronically elevated glucose levels are at increased risk for developing diabetes complications. When to See a Doctor If you don't feel like your usual self and think your blood sugar is elevated, test it to confirm. If your blood sugar happens to be elevated and it's an isolated event, odds are that you can probably get it back to normal on your own. Go for a walk or do some light exercise, drink extra water, and take your medicine as prescribed. On the other hand, if you are experiencing elevated blood sugars for several consecutive days, give your medical team a call, as you may need to tweak your treatment plan. If you don't have diabetes and notice any of these signs or symptoms, and are overweight or obese or have a family history of diabetes, you should schedule an appointment with your doctor to be screened. Microvascular complications of diabetes can occur prior to diagnosis, so the sooner you receive treatment, the better. For Parents of Children Without Diabetes If you've noticed that your child is drinking, eating, and urinating more often than usual, a trip to the doctor is a good idea, especially if you've seen a quick change in weight. If the symptoms appear to be more severe and resemble those of DKA (refer above), go to the emergency room right away. For Parents of Children With Diabetes If your child is presenting with hyperglycemia symptoms and their blood sugar is greater than 240 mg/dL, you should test them for ketones. Upon a positive test, call your medical team for guidance on what to do next or refer to your sick day plan. Depending on the severity of the ketones, you may be advised to go to the emergency room. Homeopathic remedies marketed to treat the symptoms of diabetes or prevent complications include: Syzygium jambolanum or S. cumini (black plum) is said to help treat thirst, weakness, skin ulcers, and excessive urination. Uranium nitricum is marketed to treat excessive urination, nausea, swelling, and burning with urination. Conium (hemlock) is purported to treat numbness in the feet and hands as well as diabetic neuropathy (nerve damage). Plumbum (lead) is said to help with numbness in the hands and feet, nerve pain, and tinnitus. Calendula (marigold) is said to treat infected ulcers. Phosphoric acid is promoted to treat impaired memory, confusion or heavy head, frequent urination at night, hair loss, and difficulty maintaining an erection. Candida (yeast) is said to treat yeast infections.Dr. Rajesh Gupta7 Likes9 Answers