Low Cholesterol and High LDH: Diabetes Management Insights

I would like to consult the director regarding the issues of elevated white blood cell count, low total cholesterol, and elevated LDH levels. Thank you for your response?

Hello, Director: I would like to ask about my health situation.
I was diagnosed with diabetes on April 27.
My blood test results from that day showed: fasting blood glucose 204 mg/dL, postprandial blood glucose 250 mg/dL, HbA1c 8.3%, total cholesterol 211 mg/dL, triglycerides 146 mg/dL, LDL 163 mg/dL, creatinine 0.9 mg/dL, microalbuminuria 107.9 mg/dL, GOT 57 U/L, and GPT 107 U/L.

On June 22, I had a follow-up blood test, and the results were: fasting blood glucose 102 mg/dL, postprandial blood glucose 142 mg/dL, HbA1c 6.6%, total cholesterol 90 mg/dL, triglycerides 133 mg/dL, LDL 44 mg/dL, HDL 37 mg/dL, creatinine 0.7 mg/dL, microalbuminuria 35.2 mg/dL, GOT 38 U/L, and GPT 71 U/L.

My weight was around 108 kg at the end of April and early May, and now it is about 95-96 kg.
My height is 180 cm (all values have decreased, but the total cholesterol has dropped significantly).
After I learned about my diabetes, I changed my eating habits, exercising by jogging for 20 to 30 minutes almost every day, eating a light diet, minimizing starch intake, and consuming very little meat, mostly vegetarian meals.
I eat less overall, but I occasionally have a big meal a few days within two months.
Previously, I used to stay up late almost every night, but now I hardly do.
I am also taking the diabetes medication Metformin.

My diabetes educator and attending physician both mentioned that my rapid weight loss and decrease in total cholesterol are due to my significant lifestyle and dietary changes.
I would like to ask if losing about 13 kg in these two months is normal? Also, with my total cholesterol dropping to 90 mg/dL, I wonder if this is solely due to my intentional dietary control and exercise, or if there could be other reasons? Does Metformin contribute to weight loss? If I want to prevent my total cholesterol from being too low, should I eat a bit more? Or could there be other health issues, or should I undergo further tests?
Additionally, on June 27, I had another blood test and tumor marker tests, all of which were normal.
However, the doctor noted that my LDH was 244 U/L and my white blood cell count was 12,600 cells/µL, which were both elevated.
The doctor referred me to a hematology-oncology specialist, and I am quite worried.
Does this indicate leukemia or blood cancer, or could there be another issue?

Axiang, 30~39 year old female. Ask Date: 2016/06/29

Dr. He Dongjin reply Cardiology

Please cherish our online medical resources.
When asking the same question, please specify only one physician or nutritionist.
Hello, your examination results are normal, which is great! There's no need to worry; it should be the result of your adjustments in lifestyle, exercise, and diet.
Congratulations! Based on your height, you may need to reduce your weight to around 80 kg, but take it slow; there's no need to be too aggressive.
In the future, you may also be able to gradually reduce any medications.
Your LDH level is 244, which is slightly elevated, and your white blood cell count is 12,600, also elevated.
I believe it can be monitored further.
I do not think this indicates leukemia or blood cancer.
If you are concerned, please consult a hematologist.
Take care from Changhua Hospital.

Reply Date: 2016/06/29

More Info

Your recent health journey has shown significant changes in your blood sugar and cholesterol levels, which is commendable. However, it raises several important questions regarding the implications of these changes, particularly concerning your diabetes management and the low cholesterol levels you've reported.

Firstly, let's address the substantial weight loss you've experienced. Losing approximately 13 kilograms (about 28.6 pounds) in two months is indeed a significant change. While rapid weight loss can sometimes be a cause for concern, especially if it occurs without a clear reason, in your case, it appears to be a result of positive lifestyle changes, including improved diet and increased physical activity. However, it's essential to ensure that this weight loss is not leading to malnutrition or other health issues. A gradual weight loss of 0.5 to 1 kilogram (1 to 2 pounds) per week is generally considered safe and sustainable.

Regarding your cholesterol levels, a total cholesterol of 90 mg/dL is notably low. While lifestyle changes can lead to improvements in cholesterol levels, such a low total cholesterol may raise concerns. Cholesterol is vital for various bodily functions, including hormone production and cell membrane integrity. Extremely low levels can potentially lead to health issues, including hormonal imbalances and other physiological problems. It’s crucial to discuss with your healthcare provider whether this low level is a cause for concern and what steps you might take to raise it safely. This could include incorporating healthy fats into your diet, such as avocados, nuts, seeds, and olive oil.

As for the diabetes medication you are taking, Metformin (known as 克糖錠 in your context) is primarily used to improve insulin sensitivity and lower blood sugar levels. While it can contribute to weight loss in some individuals, it is not typically associated with significant weight loss on its own. The weight loss you are experiencing is more likely due to your lifestyle changes rather than the medication itself.

Now, concerning your elevated LDH (lactate dehydrogenase) levels and white blood cell count, these findings can indicate various conditions. LDH is an enzyme found in almost all body tissues, and elevated levels can suggest tissue damage, hemolysis (destruction of red blood cells), or other underlying issues. A high white blood cell count can indicate an infection, inflammation, or other medical conditions. It is essential to follow up with your healthcare provider, as they may recommend further tests to determine the cause of these abnormalities. Elevated LDH and white blood cell counts do not automatically indicate leukemia or blood cancer; they can be associated with a wide range of conditions, some of which are benign.

In summary, while your weight loss and improvements in blood sugar levels are positive, the low cholesterol level and elevated LDH and white blood cell count warrant further investigation. It is crucial to maintain open communication with your healthcare team, who can provide personalized advice based on your overall health status and specific circumstances. Regular monitoring and follow-up tests will help ensure that any potential issues are addressed promptly.

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