Diabetologist Dr Rahul Baxi has shared an extremely interesting case on microblogging platform Twitter.
On October 19, Dr Baxi had shared the lipid profile of a 30 year old man who had been newly diagnosed with diabetes, then. The lipid report showed that the triglyceride level of the person was 3352.4, multiple times higher than the normal and acceptable level of triglyceride in the body. While the overall cholesterol was 440.7, more than double of the desirable range, the levels of low density lipoprotein or LDL and high density lipoprotein or HDL were less.
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500 ml cold drink daily!
It was the diet of the patient that had caught the attention of the netizens. He consumed 500 ml of cold drinks every day; and it was more than that if someone else was with him.
“30 yr, M
Newly diagnosed Diabetes
Breakfast- orders dosa or medu vada or vada pav
Lunch and dinner – “I like Chinese food, always from outside. I also like Thums Up”
“How much, 300 ml?”
“No, 500 ml or 1 L if someone is with me”
Meanwhile, the TG levels,” Dr Baxi had tweeted.
The Twitter thread initiated by Dr Baxi has been an open and active engagement place for doctors, experts and others since then.
Blood sugar range
To a comment asking about the FBS, PP2BS and HbA1C of the patient, Dr Baxi has replied, 320, 400 and 15.7%, respectively.
To those who are already aware of diabetes and blood sugar levels, this appears to be a serious case.
FBS or Fasting Blood Sugar is considered to be normal when it is 99 mg/dL or lower.
PP2BS or the postprandial blood sugar normal level is below 140 mg/dL.
HbA1C or the average blood sugar level for 2-3 months should be less than 5.7%.
High triglycerides and low LDL
Several Twitter users have pointed out the extremely high levels of triglyceride and low levels of LDL in the patient.
“Sir. TG very high! It looks to be Familial combined hypertriglyceridemia . They have high TG levels and high levels of very low density lipoprotein (VLDL). However LDL cholesterol and HDL cholesterol are often low. Diet high in carbs and alcohol intake can make the condition worse,” says Dr Sandeep Rai.
Quite expected. But LDL seems to be falsely low, no? Textbook case of full blown metabolic syndrome due to lifestyle, an ongoing pandemic, tweets Dr. Bhaumik Kamdar.
Do triglycerides matter?
Yes! Much of the general knowledge around cholesterol is that higher levels of LDL is bad.
Triglycerides do play an important role in the body. High amounts of these lipids harden the arteries increasing the risk of stroke, heart attack and heart disease.
Extreme levels of triglycerides as seen in this case leads to acute inflammation of the pancreas leading to a condition called pancreatitis.
The complications associated with triglycerides make it a potential marker of health.
Why was he recommended to take tests?
The patient was experiencing fatigue, nocturia and polydipsia due to which his physician asked him to take the test, says Dr Baxi.
Nocturia is a condition that wakes up the patient more than often for urination; this is commonly seen in older people and also seen in those having diabetes.
Polydipsia is a condition of extreme thirstiness.
But why the lipid test, when he was recommended to do a blood sugar test?
To this question which was asked by a Twitter user, Dr Baxi gives an ubiquitous answer which doctors hear on a regular basis.
“Good question, his family physician had asked him only for HbA1c and glucose levels because he had fatigue, nocturia and polydipsia. He said, “fir maine socha ki poora package hi kara leta hoon lab se”
However, that saved him as he could get a proper diagnosis on time.
Is it reversible?
Three days after tweeting the report, Dr Baxi had shared another screenshot of the lipid test on October 20, in which the triglyceride of the person is 1378 mg/dL, down by more than 2000 units.
“TG down by a couple of thousands with 3 days of dietary modifications and medications,” Dr Baxi tweeted. The patient was put on Fibrate and Saroglitazar apart from dietary changes.
On November 3, almost 15 days later, Dr Baxi shared another lipid test report in which the triglyceride level had further come down to 315 mg/DL. The normal range of triglycerides is less than 150 units. “And now repeated, down by a further thousand. He has made significant dietary changes and has started walking regularly. Glucose levels also improved,” tweeted Dr Baxi.
And he also gave up on cola!
Check the entire tweet here:
30 yr, M
Newly diagnosed Diabetes
Breakfast- orders dosa or medu vada or vada pav
Lunch and dinner – “I like Chinese food, always from outside. I also like Thums Up”“How much, 300 ml?”
“No, 500 ml or 1 L if someone is with me”
Meanwhile, the TG levels 🚀#medtwitter pic.twitter.com/TfWZgYHZv9
— Dr. Rahul Baxi (@baxirahul) October 19, 2022
Here are few common questions related to diabetics and cholesterol
- What are the common tests of diabetes?
The common tests that are recommended by the doctors for diabetes are fasting blood sugar, glucose tolerance test, random blood sugar test, glucose screening test, and HbA1C. - What is the normal range of fasting blood sugar level?
A fasting blood sugar level of less than 90mg/dL is considered to be normal. The level between 100 to 125 mg/dL is considered to be prediabetes. - Are diabetes and cholesterol related?
Yes. If you have diabetes there are chances you might have high levels of LDL or bad cholesterol. - How can diabetics lower their cholesterol?
Eating healthy fats, reducing intake of added sugar, consuming more vegetables and whole, nutritious foods can help diabetics to lower their cholesterol. - Can diabetes cause high cholesterol?
The American Heart Association (AHA) states that diabetes often lowers HDL (good) cholesterol levels and raises triglycerides and LDL (bad) cholesterol levels. - What is a normal cholesterol level for a diabetic?
Target LDL cholesterol levels for adults with diabetes are 40 mg/dl (1.02 mmol/l); and triglyceride levels are - What are the early signs of diabetes?
The early signs of diabetes are frequent urination, increased thirst, fatigue, blurry vision, delay in healing of cuts and wounds, and frequent hunger. - What is cholesterol?
Cholesterol is a waxy substance found in the blood that is extremely important for cellular functions. - Why cholesterol level matters?
High amounts of cholesterol pose risk to the health. These fatty substances get deposited in the blood vessel and reduce the flow of blood putting the body in greater risk.