Referral Needed: Uncontrolled Diabetes

[Ebumbu]

Hello everyone. My friend was diagnosed with severe, uncontrolled diabetes 3 days ago (10.3). It's causing havoc with asthma, uncontrolled menstrual bleeding, and anemia. I'd be grateful for refferrals for some top endocrinologists in the Bangkok area. Thank you very much! 

[JAG]

Get your friend to her local government hospital.

 

They are well set up for treating diabetes. Each hospital will hold regular diabetic clinics to monitor and control the disease.

 

There isn't a magic bullet for diabetes - medicines - insulin and oral medicines will help get the blood sugar down to manageable levels, and medicine and diet will help control it. There is a significant reservoir of experience in dealing with it - Thais are susceptible - perhaps it is their taste for sticky rice?

 

You can expect to spend time waiting around - take a book.

 

I am diabetic, and am treated in my local (rural) hospital, in fact I went for my 4 monthly clinic visit today. I arrived at 0700, was seen by the nurse at about 0730, she took details, blood pressure and asked questions about my health. Then over to the labs. Waiting, reading a book until the lab technician made her favourite giggly tannoy announcement "Khun John Anthony, put the book down and come here". Pee in that bottle (what, from here? - more giggles), then draw some blood. Wait about an hour for the results, which are sent direct to the nurse and doctors computer terminals. Meanwhile over for a quick chest X ray, then back to see a doctor (who looked about fourteen!) he seemed happy with the results. No need to change the medication. Back to the nurse, a detailed debrief on the test results, kidneys good, blood sugar under control, urine good, lose a bit of weight, how is life treating you? (Quite "holistic") Quick English lesson on why Wednesday and Thursday are named for the Norse Gods Woden and Thor(!) and off to the adjacent pharmacy to pick up 4 months supply of insulin and medication. Total cost B4600. The next two visits are cheaper as I only have chest X-ray and blood tests once a year.  All the staff, nurses, doctor, lab techs and pharmacy spoke English. Nurse Noodle (she cannot pronounce needle!) speaks excellent English, and is a Diabetic specialist.

Back home by 12.30.

 

Like I said, get your friend to the local hospital.

[scubascuba3]

She can reverse type 2, she may not be aware

[Ebumbu]

4 minutes ago, scubascuba3 said:

She can reverse type 2, she may not be aware

 

I know. But it will need meds (not the regimen from 30 years ago), right diet, and right exercise regimen. Need all of that when referring her to hospital and specialists. I'm skeptical that all this will happen at a free public hospital. 

 

Thanks. 

[howerde]

I see this lady https://www.bangkokhospital.com/en/doctor/prof-dr-somlak-chuengsamarn   my Diabetes was severe 3 years ago, i am no longer on medication, i just have 6 monthly check ups, she now teaches/practices in the public health system but does a day or so private work, i see her at Bumrungrad she does a morning shift there once a week.  as far as diet/exercise goes, there was little on that aspect from any of the doctors i saw. it seems here it is down to the patient  do the research, as there a number of medications available. you will have options by going private as opposed to the public health system 

[Ebumbu]

3 minutes ago, howerde said:

I see this lady https://www.bangkokhospital.com/en/doctor/prof-dr-somlak-chuengsamarn   my Diabetes was severe 3 years ago, i am no longer on medication, i just have 6 monthly check ups, she now teaches/practices in the public health system but does a day or so private work, i see her at Bumrungrad she does a morning shift there once a week.  as far as diet/exercise goes, there was little on that aspect from any of the doctors i saw. it seems here it is down to the patient  do the research, as there a number of medications available. you will have options by going private as opposed to the public health system 

 

A pity they don't talk about exercise and diet. However, great referral. Harvard Medical School stands out in her CV. 

[Sheryl]

 I agree with @JAG

 

Government hospitsls are well able to manage diabetes. Many have dedicated  diabetic clinics.

 

They are also  usually able to manage asthma, though in the case of community or general  hospital might need to refer if the  patient has  severe respiratory distress. 

 

Which is her registered government hospital?  

 

Her diabetes would not  explain the heavy menstruation. She has a separate GYN  condition.

 

 

 

 

 

 

 

[Ebumbu]

Just now, Sheryl said:

 I agree with @JAG

 

Government hospitsls are well able to manage diabetes. Many have dedicated  diabetic clinics.

 

They are also  usually able to manage asthma, though in the case of community or general  hospital might need to refer if the  patient has  severe respiratory distress. 

 

Which is her registered government hospital?  

 

Her diabetes would not  explain the heavy menstruation. She has a separate GYN  condition.

 

 

 

 

 

 

 

 

 

Hi. I don't know the name of her local hospital. I'll ask. 

There is also obesity as part of the picture. I know that fat can disrupt hormones. I'm learning as much as I can as quickly as I can to help here. Here's what Chat GPT had to say. I'm not questioning you and thanks for weighing in. All issues must be checked thoroughly by endocrinologist. 

--

Yes, diabetes can contribute to uncontrolled, non-stop menstrual bleeding, though it’s usually an indirect effectrather than a direct cause. The main reasons diabetes can lead to excessive or irregular menstrual bleeding include:

1. Insulin Resistance & Hormonal Imbalance

• Diabetes (especially Type 2) is linked to insulin resistance, which disrupts normal hormone levels.
• Excess insulin can lead to high estrogen levels, which thickens the uterine lining (endometrial hyperplasia)and increases the risk of heavy or prolonged bleeding.

2. PCOS (Polycystic Ovary Syndrome)

• Many people with diabetes also have PCOS, a condition where irregular ovulation and high androgens can cause prolonged or heavy periods.
• PCOS is strongly linked to insulin resistance and unpredictable menstrual cycles.

3. Poor Blood Sugar Control & Blood Vessel Fragility

• High blood sugar damages blood vessels and can make the uterine lining more prone to prolonged bleeding.
• Diabetes can impair platelet function, reducing the body’s ability to stop bleeding.

4. Increased Risk of Endometrial Hyperplasia & Cancer

• Unopposed estrogen (not balanced by progesterone) causes excessive uterine lining growth.
• Over time, this can lead to persistent heavy periods and an increased risk of endometrial cancer, which can present as prolonged or irregular bleeding.

5. Other Factors (Obesity, Medications, Stress)

• Obesity, common in Type 2 diabetes, increases estrogen production from fat tissue, worsening bleeding issues.
• Metformin & other diabetes meds can sometimes affect cycles, though they usually help regulate them.
• Chronic stress and inflammation from diabetes may also disrupt hormone balance.

 

[Muhendis]

16 hours ago, Ebumbu said:

I'm skeptical that all this will happen at a free public hospital. 

Public hospitals are just as good as private hospitals.

I would recommend attending the "after hours" evening consultations to avoid the crowds.

They are not free but they are certainly not expensive.

All normal hospital equipment is available and any required testing is immediate.

[kingstonkid]

15 hours ago, Ebumbu said:

 

 

Hi. I don't know the name of her local hospital. I'll ask. 

There is also obesity as part of the picture. I know that fat can disrupt hormones. I'm learning as much as I can as quickly as I can to help here. Here's what Chat GPT had to say. I'm not questioning you and thanks for weighing in. All issues must be checked thoroughly by endocrinologist. 

--
 

Yes, diabetes can contribute to uncontrolled, non-stop menstrual bleeding, though it’s usually an indirect effectrather than a direct cause. The main reasons diabetes can lead to excessive or irregular menstrual bleeding include:

1. Insulin Resistance & Hormonal Imbalance

• Diabetes (especially Type 2) is linked to insulin resistance, which disrupts normal hormone levels.
• Excess insulin can lead to high estrogen levels, which thickens the uterine lining (endometrial hyperplasia)and increases the risk of heavy or prolonged bleeding.

2. PCOS (Polycystic Ovary Syndrome)

• Many people with diabetes also have PCOS, a condition where irregular ovulation and high androgens can cause prolonged or heavy periods.
• PCOS is strongly linked to insulin resistance and unpredictable menstrual cycles.

3. Poor Blood Sugar Control & Blood Vessel Fragility

• High blood sugar damages blood vessels and can make the uterine lining more prone to prolonged bleeding.
• Diabetes can impair platelet function, reducing the body’s ability to stop bleeding.

4. Increased Risk of Endometrial Hyperplasia & Cancer

• Unopposed estrogen (not balanced by progesterone) causes excessive uterine lining growth.
• Over time, this can lead to persistent heavy periods and an increased risk of endometrial cancer, which can present as prolonged or irregular bleeding.

5. Other Factors (Obesity, Medications, Stress)

• Obesity, common in Type 2 diabetes, increases estrogen production from fat tissue, worsening bleeding issues.
• Metformin & other diabetes meds can sometimes affect cycles, though they usually help regulate them.
• Chronic stress and inflammation from diabetes may also disrupt hormone balance.

 

The bottom line is that she needs to get to a hospital. While a government hospital would be good, I think she needs to go to a tier 2 hospital so that she can also be referred to a specialist in all the other areas where she has trouble. 

 

Ihave diabetes and go to PatRangsit it is in the area between the hiso hospirals and teh go0vernment. Still, the doctor has the ability to move me to a diferent specialist such as and eye doctor to check if the diavbetes isaffecting my sight.  For menstruation, I would think that a gynecologist or specialist in ladies' issues would also be important to see. 

 

The wiat is also shorter at these hospitals.  She also needs immmediatley to change her diet which for a lot of people adn thais especialy is very dificult.  

 

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