Brief Answer:
Can't find attachments.

Detailed Answer:
Hi,

Thanks for your question.
Noted your concern.

Can't see attachments with your question.

There may be possibility of umbilical hernia or abscess. There is a need for detailed physical examination
In such a case I may suggest following investigations -
- Complete blood count.
- HbA1c,
- Fasting & post-prandial blood sugar levels.
- Renal function test.
- Liver function test.
- Depending upon clinical examination ultrasound of abdomen & pelvis.

Hope this helps.

Regards,
Dr Abhay Mali.
Diabetilogist.

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Brief Answer:
Sorry still not able to see any attachments.

Detailed Answer:

You may choose to send your reports to YYYY@YYYY with attention to Dr. Abhay A Mali.
You can also try to upload using the upload link.

Hope this helps.

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Brief Answer:
Chronic kidney disease & Hypothyroidism.

Detailed Answer:
After going through his test results there is a -
1) Good diabetes control (HbA1c of 6.4).
2) Kidney problem which may be due to long standing diabetes or urate nephropathy (uric acid crystals in urine).
3) Low Haemoglobin which may be due to
- Nutritional deficiency (Iron deficiency).
- Kidney problem.
4) Hypothyroidism. ( Decreased activity of thyroid gland).

His symptoms of generalised body ache & constipation may be due to Hypothyroidism or kidney problem.

in such a case I may suggest-
1) To consult his treating doctor for detailed physical examination including naval examination. There may be need fir Ultrasonography.
2) For kidney problem
Consult nephrologist. There nay be need For following evaluation.
- Ultrasound of abdomen & pelvis for kidney size, shape, echo texture.
- Urine albumin creatinine ratio.
- Fundoscopy fir retinopathy evaluation.
3) For low Hb Iron study may be suggested and accordingly Iron supplement can be suggested.
4) For Hypothyroidism thyroid supplement should be started according to his weight& heart status.

Hope this helps.

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Brief Answer:
Consult his treating diabetologist and nephrologist.

Detailed Answer:
Considering his HbA1c of 6.4 one may suggest to reduce dose of glizid with
continuation of Januvia depending upon his fasting and post-prandial blood sugar level with close monitoring of blood sugar level subsequently.

Regarding Telma electrolytes (potassium) need to be monitored as in patients with deranged kidney function there may be increased risk of hyperkalemia (increased potassium).

Ferium is iron supplement for low Haemoglobin.

Better to consult his treating diabetologist and nephrologist as clinical examination is more important in taking decisions.

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