Managing Diabetes: Weight Loss, Cholesterol Levels, and Health Concerns

Q: Managing Diabetes: Weight Loss, Cholesterol Levels, and Health Concerns

Dear Mr. Ah-Chiang： 1. Your original weight was 108 kg, height 180 cm, resulting in a body mass index (BMI) of 33.3 kg/m², which classifies you as obese. Due to insulin resistance, you are at an increased risk for type 2 diabetes. Non-pharmacological treatments

Regarding issues related to diabetes..?

Hello, Director.
I would like to ask about my health situation.
I was diagnosed with diabetes on April 27.
My blood test results on that date 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 approximately 108 kg at the end of April and early May, and now it is around 95-96 kg.
I am 180 cm tall.
(All my data has improved, but the total cholesterol has dropped too much.) After being diagnosed with diabetes, I changed my eating habits, exercising almost every day with light jogging for 20 to 30 minutes, eating a light diet, significantly reducing starch intake, and consuming very little meat, mostly vegetarian.
I eat less overall, but I occasionally indulge in 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 diabetes medication, Metformin.

My diabetes educator and attending physician both said 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? Should I eat a bit more to prevent my total cholesterol from being too low?
Additionally, I had another blood test and tumor marker test on June 27, and everything was normal.
However, the doctor mentioned that my LDH was 244 U/L and my white blood cell count was 13,900 cells/μL, which are both elevated.
The doctor referred me to a hematology-oncology specialist, and I am very worried.
Could this indicate leukemia or blood cancer?

Axiang, 30~39 year old female. Ask Date: 2016/07/28

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Ah-Chiang:
1.
Your original weight was 108 kg, height 180 cm, resulting in a body mass index (BMI) of 33.3 kg/m², which classifies you as obese.
Due to insulin resistance, you are at an increased risk for type 2 diabetes.
Non-pharmacological treatments for weight loss include dietary control, regular exercise, and behavioral therapy, with dietary control being the fundamental step.
Generally, it is recommended that individuals consume 1200-1500 kcal per day to meet nutritional needs.
Clinically, we suggest that men maintain a caloric intake of 1500-1800 kcal per day, while women should aim for around 1200-1500 kcal, or reduce caloric intake by 500 kcal daily.
This approach can lead to a weight loss of approximately 0.45 kg per week.
Rapid weight loss can sometimes result in rebound weight gain.
An unbalanced diet may lead to muscle protein loss or accelerated fat accumulation, which are important considerations.
Over the past two months, you have lost 13 kg, averaging about 1.6 kg per week, which is indeed relatively rapid.
It is advisable for you to discuss this with your physician or consult a nutritionist to explore better weight control strategies.
2.
The medication you are using, "Glycogen Tablets," is likely Uformin®, with the generic name Metformin, typically at a dosage of 500 mg per tablet.
It is the first-line medication for type 2 diabetes and obesity, with the dosage adjusted based on clinical conditions.
Besides its blood glucose-lowering effects, it may also have some weight loss benefits.
However, your weight loss is primarily attributed to dietary control and vigorous exercise.
3.
On the other hand, due to not staying up late and having adequate sleep, many studies have shown that the secretion of leptin may increase, potentially contributing to weight loss.
4.
Because you have almost eliminated meat and fats from your diet, along with rapid weight loss, your total cholesterol levels are likely to decrease quickly.
Cholesterol is essential for the production of cell membranes and various hormones; therefore, prolonged low levels may impact health.
As for whether to consume more cholesterol-containing foods, the issue is not that simple.
I recommend discussing this thoroughly with your attending physician or nutritionist; the overall caloric intake and the contents of protein, carbohydrates, fats, fiber, vitamins, minerals, and hydration should be considered holistically to avoid serious missteps.
5.
Your white blood cell count of 13,900/µL and LDH level of 244 U/L are indeed slightly elevated; however, this does not necessarily indicate leukemia.
Common conditions such as colds, acute gastroenteritis, gum inflammation, and cellulitis can also lead to increased white blood cell counts.
While leukemia can cause elevated white blood cell counts, your symptoms do not seem to support this diagnosis.
LDH is an enzyme involved in carbohydrate metabolism, found in the liver, heart, muscles, kidneys, and red blood cells, and is categorized into subtypes (LDH1, LDH2, LDH3, LDH4, LDH5) that vary in concentration across different tissues.
Therefore, it may not be directly related to blood disorders.
Your attending physician is being very cautious in recommending a consultation with a hematologist.
6.
In summary, please have a thorough discussion with your attending physician before making any decisions.

Reply Date: 2016/07/28

More Info

Managing diabetes effectively involves a multifaceted approach that includes monitoring blood sugar levels, maintaining a healthy weight, and managing cholesterol levels. Your recent health changes, including significant weight loss and dietary adjustments, are commendable and can greatly impact your diabetes management.

Weight Loss and Diabetes Management
You mentioned that you weighed approximately 108 kg in late April and have since reduced your weight to around 95-96 kg. A weight loss of 12-13 kg over a two-month period is generally considered significant and can be beneficial for individuals with diabetes. Research indicates that even a modest weight loss of 5-10% of body weight can improve insulin sensitivity and glycemic control, which is crucial for managing diabetes. Your commitment to regular exercise and dietary changes likely contributed to this positive outcome.

Cholesterol Levels
Your cholesterol levels have also shown a notable change. Initially, your total cholesterol was 211 mg/dL, and it has dropped to 90 mg/dL. While a reduction in cholesterol can be beneficial, such a drastic drop may raise concerns. The American Heart Association recommends a total cholesterol level of less than 200 mg/dL, but levels that are too low can also be problematic. Low cholesterol levels can be associated with various health issues, including hormonal imbalances and potential nutritional deficiencies.

To maintain a healthy cholesterol level, consider incorporating healthy fats into your diet, such as those found in avocados, nuts, seeds, and olive oil. These foods can help raise your HDL (good cholesterol) levels while providing essential nutrients.

Blood Sugar Control
Your blood sugar levels have improved significantly, with fasting blood glucose dropping from 204 mg/dL to 102 mg/dL and postprandial levels from 250 mg/dL to 142 mg/dL. Additionally, your HbA1c has decreased from 8.3% to 6.6%, indicating better long-term blood sugar control. This improvement is likely a result of your lifestyle changes, including increased physical activity and dietary modifications. It’s essential to continue monitoring your blood sugar levels regularly and maintain communication with your healthcare team.

Concerns About Elevated LDH and White Blood Cell Count
Regarding your concerns about elevated LDH (lactate dehydrogenase) and white blood cell count, it’s understandable to feel anxious. Elevated LDH can indicate tissue damage or disease, while a high white blood cell count may suggest an infection or inflammation. However, these results do not automatically indicate leukemia or blood cancer. Many factors can contribute to these elevations, including stress, infection, or even recent physical activity.

It’s crucial to follow up with your healthcare provider or a hematologist for further evaluation. They may recommend additional tests to determine the underlying cause of these elevated levels. It’s important to remember that many conditions can lead to these lab findings, and a thorough assessment is necessary to reach an accurate diagnosis.

Conclusion
In summary, your proactive approach to managing diabetes through weight loss, dietary changes, and exercise is commendable and has led to significant improvements in your health metrics. However, it’s essential to monitor your cholesterol levels and follow up on any concerning lab results with your healthcare provider. Continue to engage in healthy lifestyle practices, and don’t hesitate to seek professional guidance for any health concerns. Regular check-ups and open communication with your healthcare team will be key to successfully managing your diabetes and overall health.

Similar Q&A

Managing Diabetes and Cholesterol: Key Questions and Insights

Hello Dr. Hsiao, Six months ago during my health check-up, my fasting blood glucose was 123 mg/dL and my hemoglobin A1c was 8.3%. The doctor advised me to take medication for control and to focus on weight loss. After four months of effort, I have lost 25 kg (currently experien...

Dr. Xiao Yongxun reply Internal Medicine
Dear Mr. Justin: 1. If weight loss is achieved gradually, and normal weight is maintained with good dietary control and regular exercise, it is possible to discontinue medication. However, this is contingent upon lifestyle changes and maintenance. Rapid weight loss can lead to r...

Weight Loss Concerns: Stress, Health Checks, and Diabetes Risk

In July of this year, after being diagnosed, I continued to have a poor appetite and trouble sleeping. In August, I started a new job that brought a lot of stress, and I had a persistent cough after the diagnosis, which only improved by the end of September. Before the diagnosis,...

Dr. Hong Yuanbin reply Internal Medicine
Hello, regarding diabetes, a single blood glucose test is not sufficient to determine if there is a concern for diabetes. It is recommended to consult with a specialist in Metabolism or Family Medicine. As for weight loss, it is advisable to maintain a regular routine and engage ...

Managing Blood Sugar Levels: A Guide for Overweight Individuals

Hello, doctor. I am obese and have sleep apnea and high blood pressure. Currently, I am taking half of a 5 mg blood pressure medication, which has been controlling my condition for a while. My morning and evening blood pressure readings are quite stable. My primary care physician...

Dr. Lin Jianliang reply Internal Medicine
As your physician mentioned: diet and exercise management. Additionally, it is advisable to consult a nutritionist or a diabetes educator for more information on this matter. Thank you for your message.

Managing Weight and Blood Sugar: A Guide for Diabetic Patients

Hello, doctor. I have been managing gestational diabetes for 13 years with medication, but my blood sugar levels have not been ideal. My recent blood test showed a fasting glucose level of 172 mg/dL and a hemoglobin A1c of 8.5%. I am 163 cm tall and weigh 62 kg, which is consider...

Dr. Liu Hongxiang reply Family Medicine
Dear Ms. Dong, I hope this message finds you well. After reading your letter several times, I can sense your efforts in managing your blood sugar levels; please continue to maintain this. If you want to achieve weight loss effectively, it is essential to focus primarily on dieta...