Q: This question is regarding my mother who is 56 years old. Her BP is 120/70 and weight 58 kg. She is diabetic for the past 5 years and hypertensive for the last 18 years. For about 4-5 years now, she is suffering from insomnia which has resulted in uncontrolled high blood sugar level. She does walking and takes a good diet, but lack of sleep has resulted in blood sugar level not being controlled. Her sugar levels (most recent) were FBS-124 mg/dl; Urine-NIL PPBS-259 mg/dl; Urine-2.0%. She is on the following medicines currently: Prechek-2mg 1-0-1 (BF), Glyciphage 500 1-1-1 (AF), Zevit 0-0-1, Losacar-H 1-0-0, Inderal 40mg 1-0-1, Stresnil 0.5 mg 0-0-1. Her insomnia started around the time when a younger brother passed away at the age of 40 years (leaving behind his wife and 2 young children aged 3 & 1). At around the same time her blood sugar was found to be more than 500mg/dl. As she had menopause at the same time, the doctors said that high blood sugar may be due to menopause. An ultrasound scan done at that time was normal. The sugar was well under control for a while but has been uncontrollable for the past 1 year. She cannot sleep at night. We have tried lots of alternatives like exercises, yoga, etc but she has lost her sleep and her blood sugar is not under control. I request you to kindly give your advice so that she can sleep better and control her blood sugar level.

A:Menopause does not cause uncontrolled diabetes. Lack of sleep cannot directly cause uncontrolled diabetes. However, depression (which is more common in diabetics) can both cause lack of sleep and contribute to poor control of diabetes. Without a complete history and examination, it is difficult for me to guide you specifically about what changes to make for better diabetes control, but I can give some general advice. 1. At present, she needs urgent consultation with a good psychiatrist, and proper medication. Inderal and Stresnil may not suffice. 2. She should get her thyroid function (T4, TSH) tested, if not done in the past 1 year. 3. She should get her renal function (serum creatinine, urinary microalbuminuria) tested, if not done in the past 1 year. 4. In addition, she needs proper evaluation by a good diabetologist / physician, and some additional tests: a. Glycosylated haemoglobin to give the average blood glucose over the past 8-12 weeks, to be done now and every 4-6 months. b. Lipid profile: ie cholesterol, triglycerides, LDL and HDL cholesterol: at least once every year. c. Retina examination: at least once every year. d. ECG: at least once every year.