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How to manage diabetes along with high BP and heart disease?

Q: My mother is diabetic for the past 15 years and also a heart patient diagnosed with MI for the past 5 years. She even had two retinopathy operations done for her left eye. Of late for the past two months her gait has become very unsteady and she is not able to walk without support additionally for every small activity like having a bath or even getting up from the toilet seat she is feeling heavy and loss of breath. She never complains of chest pain. On administering Isordil 5 mg she regains her normalcy. Her daily activities are pretty much curtailed and her appetite is also low. She is also extremely anaemic but her body does not seem to be absorbing Iron. She has been on Conviron tabs for over year now but there is no visible change. Her vital information is BP 160/100, Blood sugar (fasting): 80 and PPBS: 130. Please advise.

A:Your mothers health needs urgent attention on several grounds: 1. Diabetes control: A single pair of F/PP Blood Glucose do not indicate anything. She needs regular home monitoring of BG at different times of the day, to find out what her level of control is, so that diet and medication can be meaningfully adjusted. Her periods of being unwell may be due to low sugar levels, which can only be confirmed by a BG test done at the time of the symptoms. In addition, she needs to get her glycosylated haemoglobin test done 2-4 times every year. This test gives an idea of the average BG, ie overall diabetes control, over the previous 2-3 months. 2. BP control: For non-diabetics, BP should ideally be maintained < 130/90mmHg. For diabetics, BP should not be more than 120/80. The reading you have sent me is too high even for non-diabetics, leave alone a diabetic with heart disease and retinopathy. 3. Heart function: Because of long-standing nerve damage, diabetics often do not have chest pain when they have angina. From your description of the symptoms, your mother may well be having angina frequently. Make sure she is seen by the cardiologist regularly, and that she is taking the medicines prescribed to her. I hope she is taking a blood thinner like low dose aspirin regularly. 4. She also needs checkup of her kidney function and thyroid function now and once a year. Either of these could cause the non-responsive anaemia and add to her other complications. Your mother needs to be regularly followed up by a good diabetologist or physician.

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