Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does My Liver Test Report Indicate?
Question: Hi Doctor
I have being having elevated SGPT/GGT/SGOT since one year, and very high triglyceride which is above 800.
I am a social drinker, consuming about 4-5 pegs once or twice a week. I abstained from alchohol completely for 3 months but GGT didn't come down.
I am about 10 kgs overweight than ideal weight.
My diabetes is under good control and recent HB1AC is 6.6.
My most recent lab test also suddenly has elevated uric acid and amylase.
I have started going to a gym, hence have been having 4-5 egg whites in a day plus two cans of redbulls.
Please help.....what do I need to do to get my elevated liver engymes and triglyceride and uric acid under control?
Current medications are Vidagliptin/Metformin :50-1000 twice daily, Olmesartan Medoxomil-Hydrochlorothiazide 40mg once daily ( for blood pressure), Glicazide Extended Release 60mg once daily, Omega 3 fatty acid (GNC) triple strength once daily.Re-started LIV52 DS last week, which I had stopped two months back.
Cheers
XXXX
I have being having elevated SGPT/GGT/SGOT since one year, and very high triglyceride which is above 800.
I am a social drinker, consuming about 4-5 pegs once or twice a week. I abstained from alchohol completely for 3 months but GGT didn't come down.
I am about 10 kgs overweight than ideal weight.
My diabetes is under good control and recent HB1AC is 6.6.
My most recent lab test also suddenly has elevated uric acid and amylase.
I have started going to a gym, hence have been having 4-5 egg whites in a day plus two cans of redbulls.
Please help.....what do I need to do to get my elevated liver engymes and triglyceride and uric acid under control?
Current medications are Vidagliptin/Metformin :50-1000 twice daily, Olmesartan Medoxomil-Hydrochlorothiazide 40mg once daily ( for blood pressure), Glicazide Extended Release 60mg once daily, Omega 3 fatty acid (GNC) triple strength once daily.Re-started LIV52 DS last week, which I had stopped two months back.
Cheers
XXXX
Brief Answer:
Please see detailed answer
Detailed Answer:
Hi XXXXXXX XXXXXXX
Welcome to HCM. I had gone through your question and understand your concerns.
Your current problems and treatment options for same are:
1. Fatty liver - elevated liver enzymes
Low fat diet
Regular aerobic exercise - 30 minutes a day
Metformin, pioglitazone (antidiabetic medications that can decrease fatty liver)
Vitamin E : 800 mg/day
Continue Liv 52
2. Hypertriglyceridemia
Omega 3 fatty acids are the drug of choice
3. Type 2 diabetes mellitus - well controlled
Continue same medications (Vildagliptin, metformin and glyclazide)
4. Increased uric acid
Try with low protein diet - avoid meat, fish, bakery products, sugar, alcohol.
Have complex carbohydrates - whole grains, vegetables, fruits etc. Drink plenty
of water.
Medications like Febuxostat Allopurinol
From your diet: decrease high protein diet (egg whites) and avoid Redbulls as it contain more refined sugars that will affect your triglycerides, sugar and uric acid.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Please see detailed answer
Detailed Answer:
Hi XXXXXXX XXXXXXX
Welcome to HCM. I had gone through your question and understand your concerns.
Your current problems and treatment options for same are:
1. Fatty liver - elevated liver enzymes
Low fat diet
Regular aerobic exercise - 30 minutes a day
Metformin, pioglitazone (antidiabetic medications that can decrease fatty liver)
Vitamin E : 800 mg/day
Continue Liv 52
2. Hypertriglyceridemia
Omega 3 fatty acids are the drug of choice
3. Type 2 diabetes mellitus - well controlled
Continue same medications (Vildagliptin, metformin and glyclazide)
4. Increased uric acid
Try with low protein diet - avoid meat, fish, bakery products, sugar, alcohol.
Have complex carbohydrates - whole grains, vegetables, fruits etc. Drink plenty
of water.
Medications like Febuxostat Allopurinol
From your diet: decrease high protein diet (egg whites) and avoid Redbulls as it contain more refined sugars that will affect your triglycerides, sugar and uric acid.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doctor.
I have the following followup queries.....
1) My Doctor shifted me from Pioglitazone-Metformin to Vildagliptin-Metformin as it was reported that Pioglitazone got banned in XXXXXXX and its banned in some European Countries. So are you recommending I have Pioglitazone,Vildagliptin,Glicazide and Metformin ....all of them?
How much Pioglitazone do I have and how many times daily?
If all four of them together cause hypoglycemia, which one should I stop? Vildagliptin or Glicazide?
2)Omega 3 alone is unable to lower my triglyceride from very high levels since last one year so do I have Atorvastatin and Fenofibrate Combination for lowering Trigliceride? If yes, How much do I have of Atorvastatin and Fenofibrate?
3)You must have noticed my report where Lipase is elevated too......is it due to chronic high triglyceride levels? I read on the net that very high triglicerides can cause acute pancreatitis. Do you think I should be concerned with the elevated Amilase levels? Do I need to be on any preventive medicine for this?
4)The report also has my Anti-CCP as positive.....do I need to be concerned?
5)I initiated high protein intake ( Egg Whites plus boiled chicken)due to starting workouts in the gym? As advised by you, I shall stop being on high protein, is it OK to be on low protein while doing moderate workouts( combination of strength and aerobics) in the gym?
6) Are the elevated counts in my report, Liver/Lipid/Uric Acid/Lipase etc normal elevations in most diabetic 40 plus men ( specially very high chronic GGT for more than a year and high Triglyceride since last 7-8 years)....and these can be altered by lifestyle and diet changes?
Thanks so much
Cheers
XXXX
I have the following followup queries.....
1) My Doctor shifted me from Pioglitazone-Metformin to Vildagliptin-Metformin as it was reported that Pioglitazone got banned in XXXXXXX and its banned in some European Countries. So are you recommending I have Pioglitazone,Vildagliptin,Glicazide and Metformin ....all of them?
How much Pioglitazone do I have and how many times daily?
If all four of them together cause hypoglycemia, which one should I stop? Vildagliptin or Glicazide?
2)Omega 3 alone is unable to lower my triglyceride from very high levels since last one year so do I have Atorvastatin and Fenofibrate Combination for lowering Trigliceride? If yes, How much do I have of Atorvastatin and Fenofibrate?
3)You must have noticed my report where Lipase is elevated too......is it due to chronic high triglyceride levels? I read on the net that very high triglicerides can cause acute pancreatitis. Do you think I should be concerned with the elevated Amilase levels? Do I need to be on any preventive medicine for this?
4)The report also has my Anti-CCP as positive.....do I need to be concerned?
5)I initiated high protein intake ( Egg Whites plus boiled chicken)due to starting workouts in the gym? As advised by you, I shall stop being on high protein, is it OK to be on low protein while doing moderate workouts( combination of strength and aerobics) in the gym?
6) Are the elevated counts in my report, Liver/Lipid/Uric Acid/Lipase etc normal elevations in most diabetic 40 plus men ( specially very high chronic GGT for more than a year and high Triglyceride since last 7-8 years)....and these can be altered by lifestyle and diet changes?
Thanks so much
Cheers
XXXX
Brief Answer:
See detailed answer
Detailed Answer:
Hi XXXXXXX
Welcome back. Good day.
No need to worry. All your blood parameters can be brought to normal range with medications and lifestyle modifications.
The answers to your questions:
1. Pioglitazone is not currently banned in XXXXXXX (It was a few months ago) There were some concerns on bladder cancer and osteoporosis. Vildagliptin has also some concerns on increasing risk of pancreatitis.
There are different medical options in diabetes. The medications depend on individual choices, side effects and response to drugs. In my practice I start only small dose of Pioglitazone - like 7.5 mg/day.
Pioglitazone, metformin and vildagliptin are associated with less hypoglycaemia. If you develop hypoglycaemia, you have to decrease or stop Glyclazide.
I have given you an option for Pioglitazone as both high triglycerides and elevated lipase make you at risk of pancreatitis - which means you may have to stop Vildagliptin if pancreatitis develop.
2. High dose of Omega 3 fatty acid (2-4 grams per day) is needed to control triglycerides. We prefer Omega 3 fatty acid as it associated with lesser side effects. Fenofibrate is available in combination with atorvostatin. We usually start with 10 mg atorvostatin + 145 or 160 mg of Finofibrate. Niacin and Insulin are other options to decrease triglycerides.
3. Lipase more than 3 times the normal upper limit is considered for diagnosis of pancreatitis. Your values are below that. High triglycerides itself can elevate lipase (without pancreatitis)due to lab interference. So we have to repeat it once triglycerides are normalised.
4. Anti CCP is a marker of rheumatoid arthritis. It makes you at risk of rheumatoid arthritis. Doesn't mean you have rheumatoid arthritis. But if you develop joint symptoms, you have to see a rheumatologist and get started on medications early.
5. You can take normal protein diet. Moderate aerobic exercise will help.
6. Your Triglycerides and uric acid are high for a 40 year old diabetic. Probably there are genetic factors involved in this. Fatty liver and borderline elevated liver enzymes are common in this age group. This can be altered by lifestyle changes. But usually familial increase in triglycerides wont come back to normal with medications and lifestyle modifications. It can be brought down to safe levels (less than 400 mg/dl).
Hope this will clear your doubts. For any further clarifications, please feel free to ask.
Regards
Dr Ajish TP
See detailed answer
Detailed Answer:
Hi XXXXXXX
Welcome back. Good day.
No need to worry. All your blood parameters can be brought to normal range with medications and lifestyle modifications.
The answers to your questions:
1. Pioglitazone is not currently banned in XXXXXXX (It was a few months ago) There were some concerns on bladder cancer and osteoporosis. Vildagliptin has also some concerns on increasing risk of pancreatitis.
There are different medical options in diabetes. The medications depend on individual choices, side effects and response to drugs. In my practice I start only small dose of Pioglitazone - like 7.5 mg/day.
Pioglitazone, metformin and vildagliptin are associated with less hypoglycaemia. If you develop hypoglycaemia, you have to decrease or stop Glyclazide.
I have given you an option for Pioglitazone as both high triglycerides and elevated lipase make you at risk of pancreatitis - which means you may have to stop Vildagliptin if pancreatitis develop.
2. High dose of Omega 3 fatty acid (2-4 grams per day) is needed to control triglycerides. We prefer Omega 3 fatty acid as it associated with lesser side effects. Fenofibrate is available in combination with atorvostatin. We usually start with 10 mg atorvostatin + 145 or 160 mg of Finofibrate. Niacin and Insulin are other options to decrease triglycerides.
3. Lipase more than 3 times the normal upper limit is considered for diagnosis of pancreatitis. Your values are below that. High triglycerides itself can elevate lipase (without pancreatitis)due to lab interference. So we have to repeat it once triglycerides are normalised.
4. Anti CCP is a marker of rheumatoid arthritis. It makes you at risk of rheumatoid arthritis. Doesn't mean you have rheumatoid arthritis. But if you develop joint symptoms, you have to see a rheumatologist and get started on medications early.
5. You can take normal protein diet. Moderate aerobic exercise will help.
6. Your Triglycerides and uric acid are high for a 40 year old diabetic. Probably there are genetic factors involved in this. Fatty liver and borderline elevated liver enzymes are common in this age group. This can be altered by lifestyle changes. But usually familial increase in triglycerides wont come back to normal with medications and lifestyle modifications. It can be brought down to safe levels (less than 400 mg/dl).
Hope this will clear your doubts. For any further clarifications, please feel free to ask.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thankyou Doctor for the detailed answers!It indeed takes away my worries :-)
I shall then re-start Pioglitazone 7.5mg once daily as per your advice.
And also start Atorvastatin 10mg Fenofibrate 160mg once daily.
Also shall check if my Omega 3 dose is 2-4g per day, if not shall increase my dose accordingly.
I shall keep you updated after 3 months and inform the progress.
Can you please let me know the trade name of Febuxostat Allopurinol? Do you think I should start taking it? How much per day and for how long do I take it?
Also the trade name for Vitamin E 800 mg?
Thanks so much yet again and have a good day!
Cheers
XXXX
I shall then re-start Pioglitazone 7.5mg once daily as per your advice.
And also start Atorvastatin 10mg Fenofibrate 160mg once daily.
Also shall check if my Omega 3 dose is 2-4g per day, if not shall increase my dose accordingly.
I shall keep you updated after 3 months and inform the progress.
Can you please let me know the trade name of Febuxostat Allopurinol? Do you think I should start taking it? How much per day and for how long do I take it?
Also the trade name for Vitamin E 800 mg?
Thanks so much yet again and have a good day!
Cheers
XXXX
Brief Answer:
See detailed answer
Detailed Answer:
Hi XXXXXXX
Welcome back.
Brand names available for Febuxostat in XXXXXXX are Febuget, Febutas, Fabulas etc. Available as 40 and 80 mg tablets. Dose is 40-80 mg once daily. You can take either Febuxostat or allopurinol (Brands - Zyloric 100 mg twice daily). Febuxostat is better. You should start taking it. We can decide on continuing it after 3 months' blood tests.
Vitamin E is available as Evion 400 mg. You can take 2 capsules per day.
Wishing you good health.
Please update on the progress after 3 months.
Regards
Dr Ajish TP
Consultant Endocrinologist
See detailed answer
Detailed Answer:
Hi XXXXXXX
Welcome back.
Brand names available for Febuxostat in XXXXXXX are Febuget, Febutas, Fabulas etc. Available as 40 and 80 mg tablets. Dose is 40-80 mg once daily. You can take either Febuxostat or allopurinol (Brands - Zyloric 100 mg twice daily). Febuxostat is better. You should start taking it. We can decide on continuing it after 3 months' blood tests.
Vitamin E is available as Evion 400 mg. You can take 2 capsules per day.
Wishing you good health.
Please update on the progress after 3 months.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doctors!
Will update after 3 months....
Cheers till then......
XXXX
Will update after 3 months....
Cheers till then......
XXXX
Brief Answer:
Wishing you good health.
Detailed Answer:
Hi XXXXXXX
If you are satisfied with the answers do write a positive review and rate the answer.
Regards
Dr Ajish TP
Wishing you good health.
Detailed Answer:
Hi XXXXXXX
If you are satisfied with the answers do write a positive review and rate the answer.
Regards
Dr Ajish TP
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
