Could I have diabetes ?

[Once Bitten]

For several months now I have been attempting to reduce my weight , with a combination of altering my food intake and two days a week fasting and moderate exercise .

Male
Age 67
Weight 83kg

BMI ( Body Mass Index ) 29.5
Height 5 feet 6 inches ( 165cm ) 
Recent blood pressure 161/73 ( taken at hospital while treating a badly cut finger ) 

When I started to try and loose weight I felt in good general health , but within a month of my diet I started to have these symptoms -

 

Symptoms (A)
Urinating more frequently 
Feeling more tired especially in the afternoons.
On getting out of bed first thing in the morning , for a brief moment I felt unsteady on my feet, but this feeling disappears quickly. 

A slight feeling that my eyes were some times not always focusing correctly ( I wear prescription glasses ) .

 

 

During my diet period- 

  

I had no feeling of increased hunger 
I felt no increased thirst.
I had a slow weight loss.
I had no headaches.

 

 

After experiencing my above symptoms ( A ) , I decided to stop my weight loss program to see what would happen .

 

One week after stopping my diet ,  I still intermittently have ( only)  the following symptoms .

 

Urinating more frequently .

Feeling tired in the afternoons.

 

From researching these above symptoms , it seems that I may have some type of diabetes .

 

I have made an appointment to see doctor next week to seek advice.

 

I am wondering if attempting to loose weight some how triggered the possibility of diabetes , as before my diet , other than feeling over weight , I felt fine and had no obvious symptoms as shown above. 

 

I know the doctor may shed some light on the above , but I am also now wondering if theres a possibility that my current symptoms could in fact be related to another un known health problem I may have and not diabetes.

[moe666]

tired in afternoon? how about cold inmorning and is it hard to get out of bed first thing if so could be thyroid. You need a complete blood test panel to see whats up

[KittenKong]

2 hours ago, Once Bitten said:

Male
Age 67
Weight 83kg

BMI ( Body Mass Index ) 29.5
Height 5 feet 6 inches ( 165cm ) 
Recent blood pressure 161/73 ( taken at hospital while treating a badly cut finger ) 

When I started to try and loose weight I felt in good general health , but within a month of my diet I started to have these symptoms -

 

Symptoms (A)
Urinating more frequently 
Feeling more tired especially in the afternoons.
On getting out of bed first thing in the morning , for a brief moment I felt unsteady on my feet, but this feeling disappears quickly. 

A slight feeling that my eyes were some times not always focusing correctly ( I wear prescription glasses ) .

 

All that just sounds like being 67 to me. I'm only 60 but I'll have two naps a day given half a chance.

 

Your BMI is much lower than mine and I weigh more than 20kg more than you. I also do the 5-2 diet. Where we differ perhaps is that I have a full medical once a year. One of the many tests is fasting blood sugar and this tells you simply and easily if you are diabetic or nearly diabetic. I'm not (quite).

 

You can get such a fasting blood sugar test done at any blood clinic for very little cost, so do it. Just remember not to eat/drink anything at all for 10 hours beforehand, apart from water.

[NancyL]

You're off to a good start in getting some blood testing.  Combine that with reduced food intake and increased exercise -- the type that brings on a heavy sweat for 45 minutes 3 or 4 times a week in an cool environ -- and you'll see some good results.  Merely sitting outside in Bangkok and sweating for 45 minutes doesn't count, unfortunately - you've got to get moving.

[Gumballl]

If your urine is foamy when it comes out, it could be a positive sign of too much sugar in the body.  Still not sure... take a piss outside, and see if the ants throw a party.

[Sheryl]

Certainly you could be diabetic or pre-diabetic. You could also have an enlarged prostate which can cause frequent urination (not an overall increase in total amount of urine, just increased frequency of urination because the bladder doesn't fully empty). The latter is more likely explanation for the increased urination since diabetes causes this only when fairly severe and uncontrolled -- but at your age and BMI you are certainly at risk for pre-diabetes/diabetes so do need to check for it. You also need to check for elevated blood lipids, and should check you thyroid and your vision. Men your age with elevated BMI often have what is variously called "metabolic syndrome" or "insulin resistance" especially if you carry your weight around the middle.

 

In short, an overall physical check-up is well overdue. All the l;arger hospitals offer this. Make sure it includes:

 

lipid  panel (HDL and LDL cholesterol, triglycerides)

uric acid

fasting glucose or HbAC1

creatnine

ALT, AST

thyroid panel

digital rectal exam

eye exam: tonometry (measure of pressure) and examination by an opthalmologist. Rule  out glaucoma, cataracts and can verify if your current eye presctription is still valid at same time.

 

The 1st 5 are pretty standard in check-up packages but you may have  to specify the last 3

 

 

[KittenKong]

19 hours ago, Sheryl said:

In short, an overall physical check-up is well overdue. All the l;arger hospitals offer this. Make sure it includes:

 

lipid  panel (HDL and LDL cholesterol, triglycerides)

uric acid

fasting glucose or HbAC1

creatnine

ALT, AST

thyroid panel

digital rectal exam

eye exam: tonometry (measure of pressure) and examination by an opthalmologist. Rule  out glaucoma, cataracts and can verify if your current eye presctription is still valid at same time.

 

The 1st 5 are pretty standard in check-up packages but you may have  to specify the last 3

 

I have a medical check-up every year and I pay around 3500B for it at Sri Racha. It includes most of those items (except the eye test which I get done by an optician in the UK) and also includes a full abdomen ultrasound which I consider very worthwhile. But is a digital rectal exam necessary these days? I never have one and the ultrasound and PSA test included in the check-up seem to give the necessary information about prostate condition.

 

For the OP, he will save time and money by having a full blood and urine test done before going to his doctor's appointment, and preferably at an outside clinic. This costs 1500B or less where I am. The results flag up any anomalies and will also help the doctor greatly if the OP does eventually want to see one. If he sees a hospital doctor without doing a blood/urine test first then it's a good bet that the first thing the doctor will do is make him have both tests in the hospital at much greater expense.

 

Or just cancel the appointment and have the proper check-up done instead. The doctors who interpret mine as part of the service know about the common problems that it can reveal, and that includes diabetes.

[Lumbini]

A1c test

[Once Bitten]

Thanks Sheryl  for you detailed advice and suggestions , and every one else for their comments and ideas, its much appreciated .

 

Over the last few days my symptoms have slightly changed , currently I only seem to be urinating more , especially having to get up to go to the toilet one ive gone to sleep, other that that I am feeling fine and now have no other symptoms. 

 

So I am leaning towards the prostate issue , I am going to see a general practitioner doctor at a large private hospital that I have use in the past and been happy with ,  to outline my symptoms and request the tests, but I’m now wondering if it would be wiser to go directly to see an urologist and outline my symptoms and request the list of tests as recommended by Sheryl . Would their be any benefit going directly to see an urologist .

 

Or as first planned just see a general practitioner doctor and request the same list of tests . 

 

Any thoughts please.

[KittenKong]

I dont know where you are but all private hospitals I have come across in Pattaya and nearby do promotional "health check" packages that cover most of the common problems for a one-off fee that is much lower than getting the same tests done individually. Sometimes these are standard packages and sometimes they vary a bit from month to month. As you are over 60 you would probably want to get the old man's set which is often euphemistically referred to as "executive". It would normally include PSA. As I mentioned, I think the full abdomen ultrasound is well worth having in my 3500B package as to have the same scan done separately once cost me 4000B on its own.

 

This is where I go http://www.phyathai-sriracha.com/en/other/Check-up-Packages.php but the monthly promo just about halves those standard rates. Once you have the results a doctor goes through them with you and it's all included.

 

Doing such a health check before seeing any other doctor will cover most of the common problems that people have.

[mommysboy]

You're doing the right thing.I think it is perhaps being overweight, ageing, and living in a hot country.  One of your blood pressure readings was high but this may have been caused by pain or anxiety.

 

The symptoms you describe during weight loss could be poor nutrition or even just sodium deficiency. I know because I went through similar when I really tried to slim down.  I pee an awful lot and that has increased with age, but was not diagnozed with insulin resistance, or prostate issue.

 

Don't imagine the worst.  This could very likely be something simple and if there is something wrong quite treatable.

 

I truth dieting is easy for most people: you eat less.  There is no other way.

[Once Bitten]

37 minutes ago, mommysboy said:

You're doing the right thing.I think it is perhaps being overweight, ageing, and living in a hot country.  One of your blood pressure readings was high but this may have been caused by pain or anxiety.

 

The symptoms you describe during weight loss could be poor nutrition or even just sodium deficiency. I know because I went through similar when I really tried to slim down.  I pee an awful lot and that has increased with age, but was not diagnozed with insulin resistance, or prostate issue.

 

Don't imagine the worst.  This could very likely be something simple and if there is something wrong quite treatable.

 

I truth dieting is easy for most people: you eat less.  There is no other way.

 

Its difficult not to imagine the worst , I have never been seriously sick in the past , so having my current symptoms has been a bit of a shock , I know I should have been more careful with my diet and exercise , but now Ive got my fingers firmly crossed that at my age ( 67 ) its not too late .

 

Thanks for your encouragement .

 

[Baanguru]

Why not go to endocrinologist? With the symptoms you are experiencing now you should be thinking to go to a doctor so he can recommend you to undergo some series of blood test. Maybe your sugar is too high or could be you have a type 2 diabetes.

[Once Bitten]

52 minutes ago, KittenKong said:

I dont know where you are but all private hospitals I have come across in Pattaya and nearby do promotional "health check" packages that cover most of the common problems for a one-off fee that is much lower than getting the same tests done individually. Sometimes these are standard packages and sometimes they vary a bit from month to month. As you are over 60 you would probably want to get the old man's set which is often euphemistically referred to as "executive". It would normally include PSA. As I mentioned, I think the full abdomen ultrasound is well worth having in my 3500B package as to have the same scan done separately once cost me 4000B on its own.

 

This is where I go http://www.phyathai-sriracha.com/en/other/Check-up-Packages.php but the monthly promo just about halves those standard rates. Once you have the results a doctor goes through them with you and it's all included.

 

Doing such a health check before seeing any other doctor will cover most of the common problems that people have.

 

KittenKong , many thanks for the information . The though of getting a ‘’ Health Check ‘’ package first has cross my mind , but I wondered if the package did not include one or more of the items on the required tests list , what could be done , would adding the extra missing tests just increase the over all cost,  to that of an independent requested selective test list . ( Sheryl’s recommended test list )

 

Sheryl’s recommended test list ...

 

Complete Blood Count ( CBC )
Uric Acid
Lipids profile ( Triglycerides and Cholesterol  / HDL / LDL )
Fasting Blood Sugar  /   HbA1c
Creatinine
Liver Function Panel  - ALT, AST
Thyroid panel
Digital rectal exam

 

I currently live about 80Km from Korat which is the nearest city to my rural location , I have in the past used St Mary’s hospital and been generally happy with the costs and results .

 

This below is from St Mary’s web site

 

http://www.smhkorat.com/Promotion/?id=77

 

Its seems to be a check up program , and the ‘’Exclusive Male ‘’ option  seems to provide a good range of tests that ( I Think ) will cover the tests that I currently need .

 

There may be some sort of current promotion offer , but I would need to telephone the hospital to find out .

 

Your comment ( Once you have the results a doctor goes through them with you and it's all included.)

 

That sounds encouraging .

 

I'm hoping that Sheryl will comment on the package shown on the St Mary's web site .

 

[Sheryl]

The package is fine provided you add thyroid panel (because of the fatigue issue, which could be thyroid).

Have the package done in the morning,, and see a urologist in the afternoon.

 

While I agree that prostate is the most likely culprit you are way overdue for an overall  check up. It  is best to catch problems like diabetes/pre-diabetes, elevated lipids etc early before you develop a problem that would yield symptoms. . An ounce of prevention, and all that..

[Sheryl]

P.S. You could save some money by just getting the  standard package and adding on HDL, LDL cholesterol, PSA and thyroid. Remember you need to add on thyroid even for the high end package.

 

 

[Once Bitten]

1 hour ago, Sheryl said:

P.S. You could save some money by just getting the  standard package and adding on HDL, LDL cholesterol, PSA and thyroid. Remember you need to add on thyroid even for the high end package.

 

 

 

 

Thanks again Sheryl

Your idea of just adding to the standard package sounds good.

 

The standard package does show - Fasting Blood , but not HbA1c , would HbA1c have to be added to the standard package as well , and the standard package is also missing Uric Acid - so if I request the standard package , with the extra test’s added the complete list would read like this ----

 

Vital Signs & physical Examination
Chest X-ray
Complete Blood Count
Urine Analysis
Creatinine
Fasting Blood Count
HbA1c ......( ? )
Cholesterol
Triglyceride
HDL ( High Density Lipoprotein )
LDL  ( LowDensity Lipoprotein )
HBsAg ( Hepatitis B Antigen )
Anti HBs ( Antibody to Hepatitis )
Liver Function
SGOT
SGPT
Uric Acid ..... ( ? )
PSA for prostrate cancer
Thyroid Panel

 Does the above list look about right, have I missed any thing ?

 

 

Thanks again.

 

 

 

 

 

 

 

[BKKdreaming]

11 hours ago, KittenKong said:

For the OP, he will save time and money by having a full blood and urine test done before going to his doctor's appointment, and preferably at an outside clinic. This costs 1500B or less where I am. The results flag up any anomalies and will also help the doctor greatly if the OP does eventually want to see one. If he sees a hospital doctor without doing a blood/urine test first then it's a good bet that the first thing the doctor will do is make him have both tests in the hospital at much greater expense.

 

Where would you get that done in BKK area ? and how long before you get the results ?

 

and how long for the results in the Standard Package ?  

 

thanks

[robblok]

15 minutes ago, BKKdreaming said:

 

Where would you get that done in BKK area ? and how long before you get the results ?

 

and how long for the results in the Standard Package ?  

 

thanks

 

Most clinics here in and around BKK do blood testing and send it to the same lab, it usually takes a day to get the results. 

[KittenKong]

12 hours ago, BKKdreaming said:

Where would you get that done in BKK area ? and how long before you get the results ?

and how long for the results in the Standard Package ? 

 

When I do mine I arrive at 10am and am gone by 2pm having had the tests, the results and the interpretation from the doctor. At least two hours of that is waiting for the results and interpretation. If I wanted to save time I would leave after the tests and come back the next day for the results and interpretation but as it takes me an hour to drive there it's pointless. So I just go and wander around the town and shops for a couple of hours.

 

I dont know how it works in Bangkok but I imagine that it is similar.

 

For tests in a clinic I just go in the morning, they take the blood and urine sample, then you either go back later or they email the results.

[BKKdreaming]

I just thought it might be a good idea to have the results at the start so you could then work off of that information  for more tests if needed , 

 

But then when I think about if , when I went in for a full physical I never talked to a doctor before testing , 

they just did the tests one after the other,  and later I talked to the doctor who just looked at the chart.....

 

UMMMM .....  maybe that is just the way its done and we are not going to change it with logic

[Sheryl]

On 9/15/2016 at 8:04 PM, Once Bitten said:

 

 

Thanks again Sheryl

Your idea of just adding to the standard package sounds good.

 

The standard package does show - Fasting Blood , but not HbA1c , would HbA1c have to be added to the standard package as well , and the standard package is also missing Uric Acid - so if I request the standard package , with the extra test’s added the complete list would read like this ----

 

Vital Signs & physical Examination
Chest X-ray
Complete Blood Count
Urine Analysis
Creatinine
Fasting Blood Count
HbA1c ......( ? )
Cholesterol
Triglyceride
HDL ( High Density Lipoprotein )
LDL  ( LowDensity Lipoprotein )
HBsAg ( Hepatitis B Antigen )
Anti HBs ( Antibody to Hepatitis )
Liver Function
SGOT
SGPT
Uric Acid ..... ( ? )
PSA for prostrate cancer
Thyroid Panel

 Does the above list look about right, have I missed any thing ?

 

 

Thanks again.

 

 

 

 

 

 

 

As long as fasting glucose included and since you have not had a prior elevated blood glucose reading, no need for hb1AC i.e. it is one or the other, no need for both.  For people known to be diabetic or pre-diabetic, the hb1AC is preferred for follow up because it reflects a sort of average for several months rather than a one pint in time snap shot. But for screening purposes (which at this stage is all you need) fasting glucose is fine.

 

You actually do not need the Hepatitis panel but it's part of the low end package so OK.

 

Uric acid not essential bit a good idea, will signal ahead of time if you are heading towards gout.

[KittenKong]

23 hours ago, BKKdreaming said:

But then when I think about if , when I went in for a full physical I never talked to a doctor before testing , 

they just did the tests one after the other,  and later I talked to the doctor who just looked at the chart.....

 

That's the way it works where I go. Makes sense to me. Of course part of the point of these health checks (for the hospital anyway) is the possibility of up-selling you some extra tests and consultations with specialists if they find anything. And in men over 60 they are almost bound to find something, even if it's only high BP.

 

I still think that the full abdomen ultrasound is well worth having as it seems to tell them quite a lot about several different organs. And it has to be more comfortable than a thumb in your rear.

 

Edited September 17, 2016 by KittenKong

[Sheryl]

An abdominal ultrasound will nto remove the need for a digital rectal exam.

 

Ultrasounds are not recommended for routine health screening in Western populations, and you won't normally find them as part of a standard check up package in a Western health facility. They are often part of check up packages in Thailand, because of the high incidence of primary liver cancer here (very rare in the West).

 

The problem with routinely doing ultrasounds when there is no clear indication is two fold:

 

(1) It leads to additional unnecessary tests/procedures since a lot of perfectly healthy people have cysts and other benign masses here and there.  This happens a lot.

 

(2) It can lead to a false sense of confidence as patients usually do not know the limitations of what can and cannot be ruled out by an ultrasound. People may assume that a normal ultrasound totally rules out any problem in the abdomen and then disregard serious symptoms that later arise.

 

Of course for patients with a specific indication (such as abnormal liver enzymes, history of hepatitis etc) it is another matter.

[Once Bitten]

18 hours ago, Sheryl said:

As long as fasting glucose included and since you have not had a prior elevated blood glucose reading, no need for hb1AC i.e. it is one or the other, no need for both.  For people known to be diabetic or pre-diabetic, the hb1AC is preferred for follow up because it reflects a sort of average for several months rather than a one pint in time snap shot. But for screening purposes (which at this stage is all you need) fasting glucose is fine.

 

You actually do not need the Hepatitis panel but it's part of the low end package so OK.

 

Uric acid not essential bit a good idea, will signal ahead of time if you are heading towards gout.

Thanks for all your help , its much appreciated

 

I will post back my test results and how the test procedure went .

 

Fingers Firmly Crossed.

 

 

 

[KittenKong]

15 hours ago, Sheryl said:

An abdominal ultrasound will nto remove the need for a digital rectal exam.

 

Ultrasounds are not recommended for routine health screening in Western populations, and you won't normally find them as part of a standard check up package in a Western health facility. They are often part of check up packages in Thailand, because of the high incidence of primary liver cancer here (very rare in the West).

 

The problem with routinely doing ultrasounds when there is no clear indication is two fold:

 

(1) It leads to additional unnecessary tests/procedures since a lot of perfectly healthy people have cysts and other benign masses here and there.  This happens a lot.

 

That's interesting. Though I wonder why no one has ever suggested doing a digital rectal exam here in all the many yearly check-ups I have had. The ultrasound comes as standard and the doctor seems to know the size of my prostate from it and can compare this with the size shown in previous tests. Also they report various cysts and fatty deposits as you mention but they have never wanted to do extra tests on them (yet). Maybe they are less money-grabbing than I give them credit for.

[Lumbini]

Premium package is what I use as my guide here for annual blood work so I get the big picture of what may be possible .
http://www.wellnessfx.com/premium

[BKKdreaming]

18 minutes ago, Lumbini said:

Premium package is what I use as my guide here for annual blood work so I get the big picture of what may be possible .
http://www.wellnessfx.com/premium

 

$925 ????  Have you found a place in Thailand to do the same tests ?

 

and for how much ?

 

thanks

Edited September 19, 2016 by BKKdreaming

[Sheryl]

On 9/18/2016 at 1:44 AM, KittenKong said:

 

That's interesting. Though I wonder why no one has ever suggested doing a digital rectal exam here in all the many yearly check-ups I have had. The ultrasound comes as standard and the doctor seems to know the size of my prostate from it and can compare this with the size shown in previous tests. Also they report various cysts and fatty deposits as you mention but they have never wanted to do extra tests on them (yet). Maybe they are less money-grabbing than I give them credit for.

 

It will be recommended  in any physical check up in the West for men above a certain age.

 

in Thailand, I think it is 1) assumed that patients won't want such an "embarassing" and invasive thing done and (2) may also be considered a "lowly" a procedure for a person of a doctor's status.In other words, cultural factors.

 

There is a similar reticence when it comes to pap smears and breast exams for women.  No way would a doctor in the west conducting a physical exam on a woman fail to do a manual breast exam and pap smear  unless the woman refused. Here, usually not done and not mentioned unless it was specifically part of the package. (The manual breast exam -- which should include instructions to the patient on how to do monthly self-exams) - costs nothing extra and can be done even when the "package" does not include a mammogram.

[KittenKong]

The full Monty at BPH is around 98,000B.

 

http://m.bangkokpattayahospital.com/en/hospital-news-en/packages-promotions-en/item/175-check-up-packages-en.html

 

And in Sri Racha their top package is about 15,000B

 

http://www.phyathai-sriracha.com/en/other/Check-up-Packages.php

 

My package there is usually around 3,500B, reduced by about 25%.