Dr Dimari's Medical Sciences Thread - Read the first post

[Sweetpea The Tigress]

Valkyrie Queen

For most of my life, I've been cold. I always thought there was nothing wrong with me (that is, I didn't realize how absurd it gets sometimes) until recently when I started noticing other little things.

For one, I sleep with lots of blankets. I live in the Southwest desert region, where most people complain about the heat. I do get hot outside like a normal person, but air conditioning systems make me get the chills after a short amount of exposure. I wear a lot of turtle necks to prevent this from happening, which usually works quite well. My feet and arms get a "pins and needles" feeling in them, and if I do something like sit and stand up, most times I go blind for a second before my vision comes back to me. The periods of blindness last for about a minute.

Lately, I've noticed my hands shake. It's not advanced like something you would see with Parkinson's, but it's still noticeable. I get weak enough to the point where it's a chore to grasp onto something like a pen. This happens especially when I haven't eaten in a while but don't feel hungry.

My feet are very sensitive to movement. My toes will start to cramp and bend the wrong way backwards on their own if I move my foot in a way that doesn't agree with it. The last time this happened I fell off my friend's bed screaming bloody murder. They last for around 10 minutes, sometimes less if I can straighten my foot out and keep still.

I also think I have a bad reaction to caffeine. Last month I went on vacation with a friend and while we were in the hotel one morning, I drank a cup of coffee before we went out to eat. While I was on the phone with someone trying to explain a stressful situation to him, I had to pause and sit down because my heart started beating erratically and quickly all on it's own. It was significant enough to impede my talking.

I've been told I have an iron deficiency, which I could believe. My diet hasn't been perfect in the last few months. But I'm wondering if I'm slightly anemic... or maybe I have poor circulation. Do you know what it could be?

Thyroid? Adrenal problems?

[Dr Dimari]

Valkyrie Queen

For most of my life, I've been cold. I always thought there was nothing wrong with me (that is, I didn't realize how absurd it gets sometimes) until recently when I started noticing other little things.

For one, I sleep with lots of blankets. I live in the Southwest desert region, where most people complain about the heat. I do get hot outside like a normal person, but air conditioning systems make me get the chills after a short amount of exposure. I wear a lot of turtle necks to prevent this from happening, which usually works quite well. My feet and arms get a "pins and needles" feeling in them, and if I do something like sit and stand up, most times I go blind for a second before my vision comes back to me. The periods of blindness last for about a minute.

Lately, I've noticed my hands shake. It's not advanced like something you would see with Parkinson's, but it's still noticeable. I get weak enough to the point where it's a chore to grasp onto something like a pen. This happens especially when I haven't eaten in a while but don't feel hungry.

My feet are very sensitive to movement. My toes will start to cramp and bend the wrong way backwards on their own if I move my foot in a way that doesn't agree with it. The last time this happened I fell off my friend's bed screaming bloody murder. They last for around 10 minutes, sometimes less if I can straighten my foot out and keep still.

I also think I have a bad reaction to caffeine. Last month I went on vacation with a friend and while we were in the hotel one morning, I drank a cup of coffee before we went out to eat. While I was on the phone with someone trying to explain a stressful situation to him, I had to pause and sit down because my heart started beating erratically and quickly all on it's own. It was significant enough to impede my talking.

I've been told I have an iron deficiency, which I could believe. My diet hasn't been perfect in the last few months. But I'm wondering if I'm slightly anemic... or maybe I have poor circulation. Do you know what it could be?

It sounds like it could be a bit of thyroid problem; particularly hypothyroidism or your underlying anaemia. I would see your GP and get checked over, there is no harm. The feeling the cold, tinglingness and cramp can be all explained by this. Don't worry if a diagnosis doesn't come back, sometimes its just one of those things, that comes in phases.

As for posture associated blindness, this is most likely a combination of anaemia and postural hypotension, the fact that your blood pressure doesn't increase quick enough with you standing up, so the pressure in your brain drops... its not fatal or problematic in someone young, but again get checked out.

As for the caffeine, it just happens to be that some people are sensitive to it. This is not an issue that can cause problems unless palpitations become affecting function. Basically, avoid strong sources of caffeine.

I suggest you see your GP for a check up, and some routine bloods: thyroid function tests, full blood count and fasting glucose.

[Dr Dimari]

Sweetpea The Tigress

I have diabetes, and I need a lot of insulin. Like for a 500 calorie meal I use 20 units of insulin. Is there a way to get my body to need less insulin?

There is no particular way for you to get your body to use less insulin, especially if you have type I diabetes. This is, as you know, because the pancreas has no B cells in the iselts of langhans in the pancreas. Therefore the body can produce no insulin to reduce the blood sugar level.

The thing you might want to consider is getting an adjustment in your insulin type, and a plan of how you take your insulin. Long acting ones you take at the day, may decrease the noumber of units you take, but it is important not to take too much for a fear of hypos. I use the Dose Adjustment For Normal Eating (DAFNE) system (part of my NHS trust in the UK), where you take 1 unit of insulin for 1 unit of carbohydrate (10g)... however, best to follow your own practitioners advice and if you want to talk to them about this, it may help to look at the most effective treatment. The key aim in DMI and DMII is to control blood glucose levels as tight as you can to prevent complications.

[Sweetpea The Tigress]

Dr Dimari

Sweetpea The Tigress

I have diabetes, and I need a lot of insulin. Like for a 500 calorie meal I use 20 units of insulin. Is there a way to get my body to need less insulin?

There is no particular way for you to get your body to use less insulin, especially if you have type I diabetes. This is, as you know, because the pancreas has no B cells in the iselts of langhans in the pancreas. Therefore the body can produce no insulin to reduce the blood sugar level.

The thing you might want to consider is getting an adjustment in your insulin type, and a plan of how you take your insulin. Long acting ones you take at the day, may decrease the noumber of units you take, but it is important not to take too much for a fear of hypos. I use the Dose Adjustment For Normal Eating (DAFNE) system (part of my NHS trust in the UK), where you take 1 unit of insulin for 1 unit of carbohydrate (10g)... however, best to follow your own practitioners advice and if you want to talk to them about this, it may help to look at the most effective treatment. The key aim in DMI and DMII is to control blood glucose levels as tight as you can to prevent complications.

Okay, thank you. 1 unit of insulin per 10 grams carb; that helps a lot. I do take Lantus, which is long acting, but it doesn't seem to do much. I will talk over changing with my MedDoc.
Thanks a lot. mrgreen

[Munkers]

Sweetpea The Tigress

Okay, thank you. 1 unit of insulin per 10 grams carb; that helps a lot. I do take Lantus, which is long acting, but it doesn't seem to do much. I will talk over changing with my MedDoc.
Thanks a lot. mrgreen

Out of curiousity, what do you mean by "it doesn't seem to do much?"

[Sweetpea The Tigress]

Munkers

Sweetpea The Tigress

Okay, thank you. 1 unit of insulin per 10 grams carb; that helps a lot. I do take Lantus, which is long acting, but it doesn't seem to do much. I will talk over changing with my MedDoc.
Thanks a lot. mrgreen

Out of curiousity, what do you mean by "it doesn't seem to do much?"

Its supposed to make my blood sugar go down in between meals. I take Apidra during meals, and that makes the sugar from the food go into my system, and the Lantus is supposed to keep feeding my body sugar from my bloodstream after the Apidra wears off.

[Munkers]

Sweetpea The Tigress

Its supposed to make my blood sugar go down in between meals. I take Apidra during meals, and that makes the sugar from the food go into my system, and the Lantus is supposed to keep feeding my body sugar from my bloodstream after the Apidra wears off.

So does that mean your blood sugar levels are still high despite taking your insulin?

[Sweetpea The Tigress]

Munkers

Sweetpea The Tigress

Its supposed to make my blood sugar go down in between meals. I take Apidra during meals, and that makes the sugar from the food go into my system, and the Lantus is supposed to keep feeding my body sugar from my bloodstream after the Apidra wears off.

So does that mean your blood sugar levels are still high despite taking your insulin?

Yes, they stay too high. I have to take a lot of insulin- more than normal. Idk why. My sister says having too much insulin circulating in your body causes physical damage, so I'd like to cut back on it and still have a good, stable blood sugar.

[Munkers]

Sweetpea The Tigress

Yes, they stay too high. I have to take a lot of insulin- more than normal. Idk why. My sister says having too much insulin circulating in your body causes physical damage, so I'd like to cut back on it and still have a good, stable blood sugar.

Have you addressed these concerns with your doctor? He/She can check your hemoglobin A1c level to determine how well your blood sugar is currently being controlled and whether or not your current insulin regimen is appropriate. Also, make sure that you're rotating your injection sites appropriately. Don't inject the same spot twice in a row, but stay in relatively the same anatomical region (like your stomach, for example) to avoid differences in absorption.

Where are you getting the information that your insulin dose is "more than normal?"

(And just for clarification, are you a Type I or Type II diabetic?)

[Dr Dimari]

In response to what both Munkers and Sweetpea The Tigress are saying:

Throughout diabetes, the body can become less sensitive to insulin that you inject. However, there is no significant damage caused by "having too much" insulin in your body; except for hypoglyaemic attacks. Although don't go crazy with your insulin, so you go Hypo, don't restrict your regime, because at the end of the day; if you're levels aren't controlled, you suffer a great risk of developing further complications. So cutting back is not the answer.

Infact, malabsorption is a good point to bring up. Ensure you are rotating your injection sites around the abdomen and thigh, as to avoid too much scaring in these areas. Also, drink more water and exercise more; two good things to help with glucose control.

Lantus is a long acting one, that provides a constant source of slow releasing insulin, to ensure a smooth glucose conc in the blood, and to allow sugar to transport into cells via the GLUT channels. The Apridra is a bolus of insulin, to rapidly encourage cells to uptake glucose from the blood, reducing the Glucose conc in blood.

HbA1c can indeed be used to see the long term picture (3 months roughly) of blood glucose control (it is seeing how much of the red blood cells contain glycoselated Haemoglobin, and expressed as a percentage). In someone who we are trying to control blood sugar level, we aim to try as hard as possible to keep this below 7%, and anything below 6% is amazing. If you are concerned, see your Primary care physician, and allow them to review your medication, and see how things are going.

Munkers: I believe Sweetpea The Tigress is DM Type 1.

[Miss Boom]

Y halo thar, fellow English dude.

My toe hurts, on and off. The pain comes and goes with no apparent pattern. I don't think it's broken because it doesn't hurt more when I put pressure on it, I don't remember having done anything recently which would break it and it doesn't feel like any of the other broken toes I've had.

It's the toe next to my big toe, right foot and I'm not sure if the pain is in the top joint, the middle joint or whether it's just all over. It doesn't seem to go beyond the base of the toe though and it's the only one which hurts. The same toe on the other foot is absolutely fine.

It doesn't feel dislocated either and I had a fungal infection there recently but that seems to have cleared up now. I've tried wrapping it up in plasters to cushion it and restrict movement slightly and that seems to help a bit but it doesn't stop it from hurting completely. Wiggling it about seems to stop it from hurting during the wiggling (as does walking) but it starts again once I stop.

This has been going on for a few weeks now.

Do you have any advice?

(Also, my phone has mysteriously come back to life. 3nodding )

[StreamLighter]

I just like wanna ask u something..
Okay I dont feel like going to the doc cuz of these headaches
and stuff

So anyways -
I've been having these horrible headaches for 6 months now
its on my left side and it hurts from the eye to the back of the head.
Ill have them for hours and hours
and if i take any kind of medication
like that ib crap or something
my stomach will be in such pain for the next 2 days or soo..
I did some research and stuff
and they said its cuz of allergies...
but ive never known for them to be this long...
So do u think it could be allergies ?
thanks :]

[Sweetpea The Tigress]

Dr Dimari

In response to what both Munkers and Sweetpea The Tigress are saying:

Throughout diabetes, the body can become less sensitive to insulin that you inject. However, there is no significant damage caused by "having too much" insulin in your body; except for hypoglyaemic attacks. Although don't go crazy with your insulin, so you go Hypo, don't restrict your regime, because at the end of the day; if you're levels aren't controlled, you suffer a great risk of developing further complications. So cutting back is not the answer.

Infact, malabsorption is a good point to bring up. Ensure you are rotating your injection sites around the abdomen and thigh, as to avoid too much scaring in these areas. Also, drink more water and exercise more; two good things to help with glucose control.

Lantus is a long acting one, that provides a constant source of slow releasing insulin, to ensure a smooth glucose conc in the blood, and to allow sugar to transport into cells via the GLUT channels. The Apridra is a bolus of insulin, to rapidly encourage cells to uptake glucose from the blood, reducing the Glucose conc in blood.

HbA1c can indeed be used to see the long term picture (3 months roughly) of blood glucose control (it is seeing how much of the red blood cells contain glycoselated Haemoglobin, and expressed as a percentage). In someone who we are trying to control blood sugar level, we aim to try as hard as possible to keep this below 7%, and anything below 6% is amazing. If you are concerned, see your Primary care physician, and allow them to review your medication, and see how things are going.

Munkers: I believe Sweetpea The Tigress is DM Type 1.

Thank you, Dr.
@Munkers- my pancreas doesn't make enough insulin... its from an endocrine syndrome, so I'm not sure what type I am... sweatdrop

[Dr Dimari]

Miss Boom

Y halo thar, fellow English dude.

My toe hurts, on and off. The pain comes and goes with no apparent pattern. I don't think it's broken because it doesn't hurt more when I put pressure on it, I don't remember having done anything recently which would break it and it doesn't feel like any of the other broken toes I've had.

It's the toe next to my big toe, right foot and I'm not sure if the pain is in the top joint, the middle joint or whether it's just all over. It doesn't seem to go beyond the base of the toe though and it's the only one which hurts. The same toe on the other foot is absolutely fine.

It doesn't feel dislocated either and I had a fungal infection there recently but that seems to have cleared up now. I've tried wrapping it up in plasters to cushion it and restrict movement slightly and that seems to help a bit but it doesn't stop it from hurting completely. Wiggling it about seems to stop it from hurting during the wiggling (as does walking) but it starts again once I stop.

This has been going on for a few weeks now.

Do you have any advice?

(Also, my phone has mysteriously come back to life. 3nodding )

Thanks for your question.
When someone comes to me complaining of pain I ask the following questions:

Where is the pain, and point? top and middle joint of the second toe on right foot
When did it first start?
Does the pain come and go, or is it constant? - on/off
When it comes on, is it sudden, or gradual?
Is it getting worse or better?
What would you describe the pain as?
Do you feel the pain spreading anywhere else?
What would you mark the pain severity out of 10 (10 being the worst pain you could ever feel)?
Have you ever had it before?
Do you get any other symptoms with the pain?
Does the pain stop you doing anything, or whats the impact the pain has on yourself?
What makes the pain better? What makes it worse? Are there any triggers? - pressure does not affect it, although no movement of the joint is more painful than movement
Have you attempted to treat it yourself, is so, how and was it helpful? - cushioning, helped some

It sounds like to me, its nothing too serious to worry about. I think you could have knocked it without you knowing and its a bit funny, it could have been broken before. Just keep an eye on it, if it gets worse, swollen, hot, or you feel a lump form, you should see your GP. But for the moment, I would be inclined to say it should go away on its own. Keep up with what you're doing if it helps, and maybe take some ibuprofen 200mg three times a day for a couple of days for the pain (don't take these if you're asthmatic, kidney problems or have any allergies to antiinflammatory medications)

Glad to hear about your phone... although weird.

[Dr Dimari]

StreamLighter

I just like wanna ask u something..
Okay I dont feel like going to the doc cuz of these headaches
and stuff

So anyways -
I've been having these horrible headaches for 6 months now
its on my left side and it hurts from the eye to the back of the head.
Ill have them for hours and hours
and if i take any kind of medication
like that ib crap or something
my stomach will be in such pain for the next 2 days or soo..
I did some research and stuff
and they said its cuz of allergies...
but ive never known for them to be this long...
So do u think it could be allergies ?
thanks :]

Well... its hard to say...

How often do you get the headaches?
When you get them, how long do they last, and do they get worse of better?
Do they come on suddenly, or gradually?
What does the pain feel like? thudding, throbbing, achey, stabbing?
Are there any symptoms you get before the headache starts? eg. Sickness, flashing lights in the eyes, wiggly lines, aversion to lights?
Are they any other symptoms you get during the headache?
Do you have any other symptoms after?
Have you notice any triggers?
Does the Ibuprofen help?

As for the ibuprofen, it can give you a stomach ache, and so its best taken with something to eat.

I really recommend you should see your GP, as horrible long lasting headache are no fun for anyone, and although they usually don't indicate anything to serious, its always best to get checked out.

As for allergies, I'm not too sure that is likely.