Brief Answer:
Investigate for kidneys/heart involvement

Detailed Answer:
Hi,

Good Day to you.

I can fully appreciate the pain and agony that your granddaughter is passing through. From the brief details, I understand that
- she is a known case of Type 1 (Insulin dependent) Diabetes, and taking Insulin shots daily.
- her legs may be swollen due to possibly diabetic nephropathy (kidney damage/failure- a complication of diabetes); heart disease (co-existing or as a diabetic complication) leading to heart failure; or clot formation in blood vessels of lower limbs. Severe anemia can also cause swelling of legs.
- significant weight loss, which may be due to diabetes itself; chronic infection such as tuberculosis, chronic Urinary infection.

However, I need more information- as given below- in great detail, to enable me to pinpoint the likeliest causes of legs' swelling and gross weight loss :-

- At what age was her diabetes detected?
- Name and dose of Insulin being taken
- Latest reports of fasting/post-prandial blood sugar levels and HbA1c
- Presence of : swelling over face/abdomen; reduced urine output, pain/burning while passing urine, passage of pus/blood in urine; ongoing fever, breathlessness on even mild exertion; breathlessness during sleep; cough with sputum; yellow coloration of eyes.

Your granddaughter will definitely require a thorough workup for conditions mentioned above. If I were to be her treating doctor, I will get her renal functions and echocardiogram as the first set of investigations which will guide me about the cause leg swelling.

Lastly, please upload all latest investigation reports (if available) for my perusal.

Am eagerly awaiting more information.

Fond regards and best wishes,

Dr. (Col) R Karanwal

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Brief Answer:
Probably has diabetic Nephropathy (Kidney failure)

Detailed Answer:
Dear Mr. XXXXXXX

Thanks for the additional information, though you have not mentioned if there is swelling over face, reduced urine output, pain/burning while passing urine, passage of pus/blood in urine, ongoing fever, breathlessness on even mild exertion; breathlessness during sleep; cough with sputum; yellow coloration of eyes.

From the information provided, I am more concerned about the possibility of diabetes induced kidney failure. I cannot comment further in the absence of investigation reports. I recommend that you consult a nephrologist and discuss her problems. Renal function tests are in order before we decide future course of treatment.

Hope I have addressed your query to your satisfaction. If you have any further questions, I will be more than happy to help you.

However, if you do not have any further clarifications, you can close the discussion and rate the answer.

Wish you a speedy recovery and good health.

Fond regards and best wishes,

Dr. (Col) R Karanwal

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