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What Causes Fluctuating Fasting Blood Glucose Test Results In An Elderly Person?
Question: Dear Dr. Shankdhar,
I am a 60 year old male, fairly fit, i do moderate exercise 5 days per week, I am not overweight and am a non smoker. I have a FBS of between 105 & 108, RANDOM of 107, 2 hours after eating 112, I have had the same FBS result for may years, is this pre diabetes? I would like to start taking metformin 250mg twice daily, or once at bedtime to see if I can bring my FBS down to below 100, should I start with the medication? I take 1,500mg of cinnamon powder capsules per day. My Mother died from Diabetes complications and her 3 sisters have diabetes.
I am a 60 year old male, fairly fit, i do moderate exercise 5 days per week, I am not overweight and am a non smoker. I have a FBS of between 105 & 108, RANDOM of 107, 2 hours after eating 112, I have had the same FBS result for may years, is this pre diabetes? I would like to start taking metformin 250mg twice daily, or once at bedtime to see if I can bring my FBS down to below 100, should I start with the medication? I take 1,500mg of cinnamon powder capsules per day. My Mother died from Diabetes complications and her 3 sisters have diabetes.
Brief Answer:
No need to start medication yet. Lifestyle modification is mandatory!
Detailed Answer:
Thanks for consulting at Health Care Magic Forum !
Your query was there on HCM unattended for many hours. Based on my clinical experience I took advantage to help you out in a timely manner as soon as system allowed me to answer you.
I have carefully worked through your case, and can well realize your health worries. Being your physician, I will take care all of your medical concerns today and will put my best efforts to get you out of this situation.
In your case, it is not the Diabetes that I am worried about. I am concerned more about the cardiovascular risk assessment related to your blood glucose levels and present situation.
Your blood glucose levels fall in Pre-Diabetic class. Medication is not the first choice of management in your case. you need lifestyle modifications. I know you are vigilant on diet and exercise but you need to do more for it.
You need to keep a regular Physical activity. Jogging is the best option if you can. At a healthy pace, you need to complete a goal of 5000 steps of jogging. Afterwards you may reduce or increase according to your body's adjustments.
Take more vegetables, fruits, salads and dry fruits. less fatty and protein diets. In proteins salmon fish is good for you. No sweets and take only skimmed milk if you like.
You need to keep you Body Mass Index right between 18-25 Kg/meter square.
I am putting you on six monthly screening test for diabetes and hypertension. You need to keep an eye on your blood sugar levels and blood presure.
Your Fasting blood sugar level should idealy be low than 100 mg/dl but if I take your category of patients it is good to be between 100-125 mg/dL. If it goes above that, then we may think of starting medications.
Right now you need some lab tests:-
1.CBC
2.Fasting Plasma Glucose
3.HbA1c levels (even though you've mentioned about it , but need clarification eg. from what time to what time you've brought them down , and when was it last done)
4.Fasting Lipid profile.
5.Kidney and Liver function tests.
Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with my expert opinion. For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).
Regards!
DR. XXXXXXX HANIF
USA
No need to start medication yet. Lifestyle modification is mandatory!
Detailed Answer:
Thanks for consulting at Health Care Magic Forum !
Your query was there on HCM unattended for many hours. Based on my clinical experience I took advantage to help you out in a timely manner as soon as system allowed me to answer you.
I have carefully worked through your case, and can well realize your health worries. Being your physician, I will take care all of your medical concerns today and will put my best efforts to get you out of this situation.
In your case, it is not the Diabetes that I am worried about. I am concerned more about the cardiovascular risk assessment related to your blood glucose levels and present situation.
Your blood glucose levels fall in Pre-Diabetic class. Medication is not the first choice of management in your case. you need lifestyle modifications. I know you are vigilant on diet and exercise but you need to do more for it.
You need to keep a regular Physical activity. Jogging is the best option if you can. At a healthy pace, you need to complete a goal of 5000 steps of jogging. Afterwards you may reduce or increase according to your body's adjustments.
Take more vegetables, fruits, salads and dry fruits. less fatty and protein diets. In proteins salmon fish is good for you. No sweets and take only skimmed milk if you like.
You need to keep you Body Mass Index right between 18-25 Kg/meter square.
I am putting you on six monthly screening test for diabetes and hypertension. You need to keep an eye on your blood sugar levels and blood presure.
Your Fasting blood sugar level should idealy be low than 100 mg/dl but if I take your category of patients it is good to be between 100-125 mg/dL. If it goes above that, then we may think of starting medications.
Right now you need some lab tests:-
1.CBC
2.Fasting Plasma Glucose
3.HbA1c levels (even though you've mentioned about it , but need clarification eg. from what time to what time you've brought them down , and when was it last done)
4.Fasting Lipid profile.
5.Kidney and Liver function tests.
Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with my expert opinion. For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).
Regards!
DR. XXXXXXX HANIF
USA
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
This was the recent tests I had done.HBA1C 02/04/2015, 5.7, 24/9/2014, 5.0, 24/03/2014, 5 .4, 23/09/2013, 5.2
CBC, 12/09/2014, total WBC 6.47, red blood cells 4.52, hemoglobin 9.1, HCT 30.5, mean cell volume 67.5, mean cell hemoglobin 20.2, mean cell hb concentration 30.0,
RBC distribution width 17.9, RBC morphology abnormal, anisocytosis 1+
Microcytosis 2+, ovalocytosis 1+ Dr. concluded anemia and gave me iron tablets.
I had a bleeding anal fissure at the time and the Dr. said that was the cause of the anemia.
Urine examination good except Ketone1+ (mg/dl )
15/10/15, FBG 105, cholesterol 154, trig 80, HDL-C 62.6, LDL direct 88,
B/P 126/84, weight with clothes on 78kg height 5.7inches. Can you give me a diagnosis and prognosis based on the above please.
BUN 22.8, ANION GAP 8.9L. General x ray, the heart and vascular structures are normal. there is no pulmonary or pleural disease. The thoracic cage is intact. impression normal chest
CBC, 12/09/2014, total WBC 6.47, red blood cells 4.52, hemoglobin 9.1, HCT 30.5, mean cell volume 67.5, mean cell hemoglobin 20.2, mean cell hb concentration 30.0,
RBC distribution width 17.9, RBC morphology abnormal, anisocytosis 1+
Microcytosis 2+, ovalocytosis 1+ Dr. concluded anemia and gave me iron tablets.
I had a bleeding anal fissure at the time and the Dr. said that was the cause of the anemia.
Urine examination good except Ketone1+ (mg/dl )
15/10/15, FBG 105, cholesterol 154, trig 80, HDL-C 62.6, LDL direct 88,
B/P 126/84, weight with clothes on 78kg height 5.7inches. Can you give me a diagnosis and prognosis based on the above please.
BUN 22.8, ANION GAP 8.9L. General x ray, the heart and vascular structures are normal. there is no pulmonary or pleural disease. The thoracic cage is intact. impression normal chest
Brief Answer:
It is a very good prognosis profile based on tests !
Detailed Answer:
Warm welcomes with this follow up. I appreciate your efforts and want to assure there is no major risk involved and the management plan aforementioned remain good for you. You have pretty good blood work reports and the X Ray findings are also unremarkable and normal. You just need to keep regular physical activity and to repeat the blood work after 4-6 weeks to see the impact of that lifestyle changes on your health.
Labs needed:
1. CBC with ESR and Differentials.
2. Fasting Plasma Glucose. and HbA1c levels.
3. Fasting Lipid profile.
4. Kidney and Liver function tests
Your weight isn't an issue as it makes a good BMI. The physical activity and healthy diet is for the best of your health not only for weight reduction.
Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with my expert opinion. For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).
Regards!
DR. XXXXXXX HANIF
USA
It is a very good prognosis profile based on tests !
Detailed Answer:
Warm welcomes with this follow up. I appreciate your efforts and want to assure there is no major risk involved and the management plan aforementioned remain good for you. You have pretty good blood work reports and the X Ray findings are also unremarkable and normal. You just need to keep regular physical activity and to repeat the blood work after 4-6 weeks to see the impact of that lifestyle changes on your health.
Labs needed:
1. CBC with ESR and Differentials.
2. Fasting Plasma Glucose. and HbA1c levels.
3. Fasting Lipid profile.
4. Kidney and Liver function tests
Your weight isn't an issue as it makes a good BMI. The physical activity and healthy diet is for the best of your health not only for weight reduction.
Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with my expert opinion. For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).
Regards!
DR. XXXXXXX HANIF
USA
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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