Managing Diabetes and Cholesterol: Key Questions and Insights

Q: Managing Diabetes and Cholesterol: Key Questions and Insights

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

Regarding diabetes and cholesterol issues?

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 experiencing a bit of a plateau).
In my most recent check-up at the end of January, my fasting blood glucose was 89 mg/dL and my hemoglobin A1c was 5.3%.
The doctor said this is excellent and encouraged me to continue my weight loss efforts.
He also agreed that I could try reducing my diabetes medication (currently taking one Glucophage 500 mg and one FORXIGA 10 mg in the morning, and one Glucophage 500 mg in the evening, with the evening dose being stopped).
I will have a follow-up in three months.
My total cholesterol was 119 mg/dL (is this considered low?), my HDL (good cholesterol) was 38 mg/dL (is this too low?), and my LDL (bad cholesterol) was 61.7 mg/dL.

I have a few questions for you, Dr.
Hsiao:
1.
Is it possible that I could stop taking medication after reaching a normal weight? (I am concerned about needing to take medication for life.)
2.
I read online that having low cholesterol is also not good.
Are my cholesterol levels acceptable?
3.
Recently, I have been experiencing frequent dizziness and a feeling of pressure in my head.
Could this be related to my blood sugar or cholesterol levels?
Thank you in advance for your response.

Justin, 30~39 year old female. Ask Date: 2017/02/24

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 rebound weight gain, and as the body ages, insulin secretion and function may decline, potentially resulting in elevated blood sugar levels again.
In other words, there is no need to worry excessively about lifelong medication; there are many variables in the future, and you may not need medication, or you may still require a small amount.
2.
Cholesterol is very important for the human body as it is a precursor for the synthesis of many hormones, such as testosterone, estrogen, progesterone, and corticosteroids.
Cholesterol is derived not only from food but is also produced by the body itself.
Therefore, having low cholesterol can indeed cause some physiological changes.
A total cholesterol level of 119 mg/dL is slightly low; however, it should not cause any adverse effects.
It is recommended that you maintain a balanced and adequate diet during your weight loss process.
If possible, please discuss this in detail with your attending physician or nutritionist.
3.
Dizziness and a feeling of fullness can occur in many situations.
It may be due to discomfort, a cold, hypoglycemia, electrolyte imbalance, inner ear issues, etc.
It could also be a side effect of medication or caused by other diseases.
Of course, the relationship with blood sugar or cholesterol cannot be completely ruled out.
4.
The Glucophage® (Metformin) you are taking is a first-line medication for type 2 diabetes.
Its pharmacological mechanism is not fully understood, but it can increase insulin receptor sensitivity and glucose metabolism, reducing sugar absorption.
Side effects may include diarrhea, bloating, or vitamin B12 deficiency.
Forxiga® (Dapagliflozin) is an SGLT2 inhibitor, which works by inhibiting glucose reabsorption in the kidneys, allowing glucose to be excreted in urine instead of being reabsorbed into the bloodstream, thereby lowering blood sugar levels.
However, the most common side effect is urinary tract infection.
Your physician is very skilled, and the medications chosen are very appropriate for your current condition, with a low incidence of hypoglycemic coma.
5.
It is advisable that you continue to discuss your concerns and questions with your attending physician for clarification.

Reply Date: 2017/02/24

More Info

Managing diabetes and cholesterol is a critical aspect of maintaining overall health, particularly for individuals who have experienced elevated blood sugar levels and are at risk for cardiovascular diseases. Your recent health journey, including significant weight loss and improved blood sugar levels, is commendable and indicates positive changes in your lifestyle. Let’s address your questions one by one.

1. Possibility of Stopping Medication After Weight Loss: It is indeed possible for some individuals to reduce or even stop their diabetes medications after achieving significant weight loss and improving their blood sugar control. However, this is contingent on several factors, including maintaining a healthy lifestyle, regular monitoring of blood sugar levels, and the underlying causes of your diabetes. Type 2 diabetes can often be managed effectively through lifestyle changes, including a balanced diet and regular physical activity. However, it’s essential to work closely with your healthcare provider to determine the best course of action for you. They can help monitor your progress and make informed decisions about your medication needs.

2. Cholesterol Levels: Your total cholesterol level of 119 mg/dL is indeed on the lower side, but it’s important to consider the context of your overall health. While low cholesterol levels can be concerning, particularly if they are associated with malnutrition or other health issues, your levels should be interpreted in conjunction with other factors, such as your diet, physical activity, and overall health status. The HDL (good cholesterol) level of 38 mg/dL is considered low; higher levels of HDL are generally protective against heart disease. It may be beneficial to discuss dietary changes or lifestyle modifications that could help raise your HDL levels, such as incorporating healthy fats (like those found in avocados, nuts, and olive oil) and engaging in regular physical activity.

3. Symptoms of Dizziness and Head Pressure: The symptoms you are experiencing, such as dizziness and a feeling of pressure in your head, could be related to several factors, including fluctuations in blood sugar levels, dehydration, or even side effects from the medications you are taking. It’s crucial to monitor your blood sugar levels closely, especially if you are experiencing symptoms that could indicate hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Additionally, if you are on medications like Glucophage (Metformin) and Forxiga (Dapagliflozin), be aware of potential side effects, which can include gastrointestinal issues or changes in hydration status. If these symptoms persist, it’s advisable to consult your healthcare provider for further evaluation.

In summary, your journey towards managing diabetes and cholesterol is commendable, and it’s essential to continue monitoring your health closely. Regular check-ups with your healthcare provider, maintaining a balanced diet, and engaging in physical activity are key components of effective diabetes management. If you have further questions or concerns, don’t hesitate to reach out to your healthcare team for personalized advice and support.

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