Have Been A Spine TB Patient, On Medication. Developed Diabetes, On Insulin. Have Gained Weight. Advise?

Hi XXXXXXX

Thanks for your question. My name is Dr Omer and I am here to help you today with your question. I will be happy to assist you with your follow up questions also.

I am sorry to hear about your problem.
As you have told that you are a patient of spinal Tuberculosis and newly diagnosed diabetic.
First of all I would say that you had almost completed the anti tuberculosis treatment and after 2- 3 months you won't take those medicines. Your doctor must be giving you dexamathasone (steroids) to cause less damage to spinal nerves and you should take them.
Steroids have a problem of causing excessive water retention in body with central obesity and it is said if you take steroids more than 6 months 10 -15 kg of body weight increases. Secondly, steroids tablets causes burning sensation in stomach and the patient eat more, so its a vicious cycle of gaining weight and plus steroids causes diabetes while rest of the anti tuberculosis are not famous for obesity or diabetes.

International guidelines suggest 2-3 months of steroids course in spinal tuberculosis. Consult your physician again. You will lose a lot of weight once your doctor stops the steroids. It will take 2-3 months to see a significant weight loss after stopping of steroids in tapering way or alternate day regimen.

May be your first sign of diabetes was spinal tuberculosis or steroids induced diabetes, means that you are prone to develop diabetes in coming years. More than one half patients don't remain on insulin after stopping steroids.

I wish you good luck that you get well soon. If you have any question, please ask because our discussion always remains open so you can always ask more till you are satisfied. You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to assist you always.

Regards

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Hi again XXXXXXX

First of all let me tell you AKT anti-tubercular drugs are very effective to kill tb completely. It is the bad thing, fibrosis, they leave when they die that causes all symptoms, and that fibrosis is treated with steroids.

As I have told you that your obesity is related mostly to your steroids used for spinal tb or the insulin use itself causes obesity especially in European people.

Akt is a kit having four drugs which are
1. isonoazid.... Depression, bald patches , burning sensation at stomach hence more eating, mild hepatitis
2. rifampicin...liver problems, orange colored urine
3. pyrazinamide ..... Joints pain, sugar, burning urination
4. ethambutol.... Eye sight problem, red green blindness

Your new symptoms of joint pain and aches is due to pyrazinamide, and the pain at the back with stiffness radiating at back of your thigh till knee seems to be result of spinal tb and increased weight, keep on doing light to moderate exercise like gym, yoga, brisk walking ....they are very effective to counter act the residual damage of TB.

Bald patches are due to both isoniazid and TB, patch will go away when you will stop anti-tb drugs in 3-5 months.

Anti tb drugs do have a lot of side effects but new companies have refined them for less side effects.

Just complete the akt course even if there are side effects. Its said that it is important to take akt even with side effects. Because all side-effects are treatable and almost all side effects are gone in 2-3 months after discontinuing akt

I have 1 question ........ Do u have pink striae at your thighs or abdominal area?

If any more questions ... I will be happy to answer.

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Hello XXXXXXX

Thank you for understanding what I told you.

As you have said you have pain at your back, it’s severe and its causing tearing pain.
This is due to the nerves infected and mild damage to nerves that supply your back due to TB and are known as neuropathic pain due to nerves that is always tearing in nature (comes and goes).
You need to get nerve regrowther like pregabalin, effexor, vitamin b12 , amitryptiline....The results are slow but significant pain reduction.

Pink straie at arms... meaning your adrenals have increased in size causing excessive cortisol and hence high fat in your body....it can be due to steroids induced or you have cushing disease(adrenal gland increased)...get a serum cortisol and ACTH level done...and discuss this with your doctor as a cause of your obesity.
I hope you are satisfied and I tried to explain what’s best for you
Stay happy, diseases come and go ...face your diseases boldly ...don’t let your TB win over You.
Take care XXXXXXX

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