Article Contributed by Dr.Swesh Kaur – Sahamm
Mr Y is a 34 year old gentleman with metabolic syndrome.
He was obese and was diagnosed to have diabetes, hypertension, hyperlipidemia 2 years ago and was commenced with Insulin 40 units bd, metformin 1 gm on, micardis, lipitor 20mg on. His fasting blood sugar with this treatment ranged from 10 to 13 mmol/l.
One year on conventional treatment, he developed discolouration, pain and paraesthesia of the toes of his left foot and one month later the similar symptoms appeared on the fingers of his left hand.
He was thoroughly investigated, dopper was normal and a diagnosis of Reynaud’s was made. He was commenced on aspirin and plavix. However his symptoms continued to affect his daily routines.
He was jointly managed by Datuk Dr Selvam and me in May 2015, the results of his initial tests were as follows (prior to intergrative treatment):
Fasting glucose= 16.0mmol/L (reference range 3.9 – 5.5mmol/L; optimum range 3.5-4.8mmol/L)
HbA1c= 11.2(reference range =6.1; optimum range <5)
Fasting serum insulin= 25uU/ml(Reference range <11; optimum range <5.7)
Renal profile was normal, liver showed fatty changes
Total cholesterol =5.6, TG =2.17, HDL=1.15, LDL=3.46
TSH =2.29 mIU/L(reference range 0.4-4.7; optimum range <2)
T4 =17.3 pmol/L(reference range 9.0-25.0; optimum range 20-22 pmol/L)
FT3= 5.2 pmol/L(reference 3.5 to 6.5; optimum range 5.0-5.5 pmol/L)
Free testosterone =28.28 pmol/L (ref; 30.9-147.5; optimum 75th percentile of upper limit)
SHBG= 21.3nmol/L(ref 15-70)
hsCRP =9.3 mg/l(ref: <1)
Serum Estradiol =189 pmol/L(ref <130; optimum range 20-30pmol/L)
DHEAs= 215 ug/dL(ref; 115-485; optimum 75th percentile of upper limit)
25-hydroxy Vitamin D = 22.8 nmol/L(ref: 60-160; optimum 75th percentile of upper limit)
Serum cortisol 309nmol/L (ref: 120-620)
He was given intravenous vitamin C and had pain releif after the drip.
Regular intravenous vitamin C and chelations were done which further improved the colour of his fingers and toes.
Patient was treated for gut dysbiosis and insulin resistance.
Supplements given included Omega 3 fish oil, cucumin, vitamin D3, Magnesium, zinc, chromium, vitamin c 6 gm/day,and multivitamins.
His low testosterone, thyroid and suboptimal DHEA were corrected.
He currently has stopped his insulin, micardis,lipitor, aspirin and plavix.He continues to take metformin 500mg nocte,
His blood pressure is normal and his fasting sugar ranges from 5 to 7 mmol/L.
The discolouration on his left hand has subsided with occasional mild discomfort. His toes have improved in colour and pain is intermittent.
We are currently awaiting the results of his next blood test.
Dr Swesh Kaur