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Why has my diabetic husband started looking lean?

Q: My husband (age 33 years) was very energetic and handsome. Last year he had diabetic symptoms and it was found that fasting (F) sugar was 261 mg/dl and post-prandial (PP) 464. He was advised Rocicon for 10 days and his blood sugar levels came down (F: 100 mg/dl & PP: 115 mg/dl). Till today his blood sugar levels have not exceeded that level. My husbands face has become very lean and his muscles have become loose. He is not maintaining any diet control and is taking every sweet food he wants. There is no weight loss and his appetite is OK. Normally, if a diabetic takes any sweet item or excess food, his blood sugar levels rise automatically but there is no increase in blood sugar in my husbands case. What further tests are required and what treatment shall be required to get his muscles tight. SGPT is also OK and HbA1c is 6.8.

A:You have not specified: - how often the blood sugars are being tested, - whether you are doing any sugar monitoring at home, - how often the HbA1c has been tested (it is almost 1 year since diagnosis, so it should have been done at least 3-4 times by now), - what is the normal range of HbA1c in your lab, and - whether your husband is experiencing any hypoglycaemic (sugars too low) episodes. Also it is not clear how he could have become lean with loose muscles and yet have no weight loss. It is difficult to give specific advice with incomplete information and no examination, but some general points relevant to him I can make: 1. Sugar is not absolutely forbidden for diabetics, though they should not take sugar in excess. If your husband has been given too many unrealistic restrictions, this may be his way of expressing resentment. 2. If your husband is not following the 6 meal pattern (3 meals, and 3 mid-meal snacks, especially between breakfast and lunch) he may well be getting hypoglycaemic (sugars too low) at times. Very low sugars can be dangerous, and may lead to the body demanding sugary foods in order to raise the sugars to safer levels. 3. Too tight a control can be dangerous if hypoglycaemia is frequent, and can only be achieved by means of frequent self home blood sugar monitoring, so that hypoglcaemias can be prevented and tackled if they do occur. 4. Regular exercise is essential for everyone, but more so for diabetics, and even more so since your husband needs to regain muscle tone. However, he has to make sure his sugars are not low when he exercises, as this can make a bad situation worse. I would strongly advocate you contact and keep in regular touch with a good endocrinologist. With proper handling of diabetes and good glycemic control, there is no reason why your husband should not be restored to his previous handsome self, though he will have to be a little more disciplined than before.

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