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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18461
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hi, I was diagnosed with type 2 diabetes in 2008. I started

Customer Question

Hi, I was diagnosed with type 2 diabetes in 2008. I started on sytagltin in Feb 2014 after metformin and glucophage meds gave me hives.
Since before 2008, infrequently I had unexplained bouts of random, sudden-urgent-toilet-need diarrhoea, fatigue and prickly sensations in hands/feet extremities and face. My GP told me that all diabetic bloods measures and tests are within the acceptable NHS limits.
In June 2014 I suffered "thunderclap headache" all brain scans were clear. For the 4 months since then I've had continuous dull headache, exacerbated and more frequent symptoms of diarrhoea, fatigue and painful joints. From GP, I requested diabetic tests& bloods, and I'm told that the measures are within acceptable limits. An eye test revealed inflammatory markers and blood tests for this reveal slightly raised levels, but nothing extreme.
Over the 6 years I've gained weight despite eating less and exercising far more. My diet has always been very healthy with no excess alcohol or indulgent foods. I exercise moderately.
I'm not depressed, have no psychological problems or family/work stresses. I need to know what to do to get back to feeling well. At present I feel very debilitated and extremely frustrated! Could I have an endocrinology problem? If so how do I find a good diabetology endocrinologist in North-west UK? Is there any other self help I could try in the meanwhile?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
What is your blood sugar currently running?
What was your most recent HgbA1c?
Customer: replied 2 years ago.
My blood sugar ranges between on average 7 & 9 mmols/L and I don't know the HgbA1c reading but my General practitioner informed me that it was fine.
Expert:  Dr. D. Love replied 2 years ago.
I'm sorry for the delay, but I was dealing with another urgent situation.

These blood sugars are not ideal, but your doctor is apparently considering the HgbA1c as the sole target to achieve.

Has there been any evaluation of thyroid function, such as a TSH?
Customer: replied 2 years ago.
What is TSH?
I've gained weight and can't shift it, I feel cold to the bone when it's warm temperatures and I feel fatigue. I'm not sure which specialist I need to see.
Expert:  Dr. D. Love replied 2 years ago.
TSH stands for thyroid stimulating hormone, which also describes what the hormone does (stimulate the thyroid). It is a hormone that is released by the pituitary gland based on ongoing brain measurement of thyroid hormones. If the brain perceives the thyroid hormone levels to be low, it will direct the pituitary to release more TSH to try to get more release of thyroid hormone. If there is hypothyroidism, so that the thyroid hormone levels are low, the TSH levels will be elevated, but the thyroid is unable to respond and release more thyroid hormone. Consequently, a blood TSH level is the most sensitive test to detect thyroid disease.

Do you know whether a TSH level has been checked?
Customer: replied 2 years ago.
No I'm not sure if a specific TSH measure has been done. My GP told me that all my blood tests including thyroid function were acceptable. I don't know the exact readings.
The only readings that were slightly raised were something to do with liver function and slightly raised inflammatory markers which were too low to indicate any rheumatology, but could be the result of fighting infection.
Expert:  Dr. D. Love replied 2 years ago.
If he said thyroid tests were normal, then he would likely have checked a TSH.
Do you know which liver tests were abnormal?
Customer: replied 2 years ago.
No
Customer: replied 2 years ago.
No.
Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

In this situation, there are several issues that would warrant further care.

First, since the blood sugars are not optimally controlled, then it would be appropriate to consider more aggressive diabetes treatment. It is true that the level of HgbA1c is a good predictor of diabetes complications, but it is the level of blood sugar that causes any current symptoms of diabetes, so in someone with symptoms, it would be appropriate to treat the diabetes more aggressively.

However, it also would be appropriate to consider other medical conditions that could be contributing to these symptoms. Certainly, thyroid dysfunction would be a major concern, so it is good that your doctor has already checked thyroid blood tests. Since there is an elevation of liver tests along with inflammatory markers, it would be appropriate to next perform further evaluation of the liver. The specific evaluation would be guided by which tests were abnormal (certain tests suggest a problem with the cells of the liver, while other tests suggest a problem with drainage of bile from the liver), but it is common that the next test would be an ultrasound of the liver.

As for how to find a specialist, you can ask your GP for a referral, but there also are some online resources to assist patients in finding a doctor that is close to you without referral from your GP. See http://www.patient.co.uk/find_me, and follow the links for finding a doctor.

Until you can be seen, you are doing most of the important interventions - eat a good diet and exercising regularly. It also would be appropriate to be drinking plenty of fluids to assure adequate hydration.

If I can provide any further information, please let me know.
Dr. D. Love and other Medical Specialists are ready to help you
Customer: replied 2 years ago.
Thank you Dr Love. I have requested a referral from my GP to see an endocrinologist/diabetologist.
Are there any foods or food supplements I can take as self help in the meanwhile?
Expert:  Dr. D. Love replied 2 years ago.
The primary issue with foods are to avoid the bad foods - foods that contain concentrated sweats or fats, as well as avoiding alcohol. It would be better to be eating high fiber foods, including vegetables and whole grains.

There is no solid evidence that food supplements will be helpful in this situation, but if you want to try a supplement, the supplements that are purported to help include chromium, coenzyme Q10, bitter melon, and fenugreek.