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How can diabetes and hypothyroidism be managed together?
Question
My 56 years old mother is diabetic for the last 30 years. She is taking insulin along with Glycomet 850 twice daily. Insulin dosage: (taken for the last 2 years) - Levemir Flexpen: 10 points (at night) and Novorapid Flexpen: 10 points (in morning). Recently, she was complaining about occasional numbness around her face and palpitations in the morning. We did a T3, T4 and TSH tests and found that the TSH level was about 12.6 mg/dl. LFT and ECG were also done recently and they appeared to be normal except for the SGGT appearing to be 55.0 u/i. The doctor advised her to take Thyronorm 50 mcg empty stomach daily. But after taking this medication for about 5 days, things have deteriorated. Her appetite has decreased and at times she develops a vomiting tendency. We have checked her blood sugar levels and the fasting count appears to be 159 mg/dl for the last 2 days. The dosage and power of Thyronorm, which was prescribed by the doctor was not suiting her. Please advise.
Expert Answer
D
Prof Dinesh DhanwalMay 11, 2009
Prof of Medicine and Head of Endocrinology,
Maulana Azad Medical College,
New Delhi
Maulana Azad Medical College,
New Delhi
Your mother has two problems: diabetes mellitus and hypothyroidism. Regarding her diabetes: get HbA1C, which tells about glucose control in last three months. It should be less than 7. I feel a single dose of Novorapid may not be enough and she may need Novorapid before lunch and dinner as well. To bring her fasting sugar to a desirable level, increase her Levimir to 12 units daily. She has hypothyroidism as well, which is mild. To know the cause of hypothyroidism get Anti-TPO done. Also get a lipid profile and ECG done. If need be, get a detailed work up for her heart from a cardiologist. Reduce the dose of Thyronorm to 25 per day and increase slowly to 37.5 after a week and then 50 next week. Keep Thyronorm 50 for next four weeks. Get TSH done after 6 weeks of starting treatment to know the exact dose she needs.
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