الأجابة

د. بشار نعمات فاضل سهر

Hi. The test results shows that u have uncontrolled diabetes. Ur HbA1c is 11.54%. This can be the explanation of ur sleep disturbances and stomach upset. I need to know ur BMI (weight and height) and the type of medications u r taking for diabetes other than diamicron MR. Ideally u should start taking at least a single shot of insulin (if u r not taking already). Have u ever tried taking (glucophage) in the past?. Please note that u need to do a blood test called (C-PEPTIDE) as having fasting insulin of 4 in the presence of high blood sugar indicates insulin deficiency and this can be detected by the C-PEPTIDE blood test. HOMA IR test that u did is misleading and even if it is normal it doesn't mean that u don't have insulin resistance. Insulin resistance in your case can be diagnosed based on clinical parameters such as your body weight and in case u need high dose of insulin to control ur blood sugar rather than based on the fasting insulin test. Hope u find it useful.

الأجابة

د. بشار نعمات فاضل سهر

Hi. The level of free thyroid hormones are high but her TSH is 3.45 which is OK.One possible explanation for her thyroid function tests is that she is taking her thyroxine erratically OR could be due to technical laboratory issue.Bearing in mind that she has never been prescribed thyroxine for 26 years post surgery I suggest that she can hold thyroxine for 4 to 6 weeks and redo TSH T4 T3after 4 to 6 weeks.Make sure that she is not taking any biotin supplements before the test.Hope u find it useful.

الأجابة

د. بشار نعمات فاضل سهر

Hi. Though i agree that the optimal dose for her is 100 ug based on the test result, however, It is advisable to gradually increase the dose in the elderly population.I suggest that she should take 75 ug daily and recheck after 6 weeks. Bear in mind that the TSH target for a 65 year old lady is 2.5-5 mIU/L.She also has to do further assessment for her weakness such Haemoglobin, sodium, blood sugar, vitamin D and B12 plus and ECG and Echocardiogram for the heart.Hope u find it useful.

الأجابة

د. بشار نعمات فاضل سهر

Hi. If you are sure that you were regularly taking your pills at least 30 minutes before breakfast then the best next step is to increase the dose 800 ug per week that is taking 2 tablets on friday and 1 tablet the rest of the week and recheck after 6 weeks. Hope u find it useful.