Dear Mr XXXXXXX

Thank you for the wonderfully written details about your health.
Let's discuss about your problems one by one.
1. Headache- You have gotten your eyesight checked which is normal and headache compulsorily comes when you are at work, your random sugar was 180 mg/dl at about 12 noon and most importantly headache is between 3 to 5 pm. These things suggest it is likely that your sugar drops down to 60 to 90 mg/dl when a few people feel headache as a symptoms of hypoglycemia or near hypoglycemia (eventhough it is more than 70, but less than 90). Hence hot coffee or rubbing with something makes you feel better- sign of frontal (forehead) headache. When your blood pressure is 120/77, it is absolutely fine and hence your blood pressure medications are fine. So reduce the pre-breakfast dose of Inj Mixtard by 2 to 3 units (make it 11 to 12) and see the difference. You should not get the symptom. Your post meal sugar checked at 12 noon might go up slightly say upto 186 or so. And that is fine. Try it for 2 days and if it does not give relief please write me back.
2. Muscle cramp- This kind of muscle catch is suggestive of lower vit D levels. So you can treat yourself with Vit D available over the counter- Calcirol Satchet- one satchet to be taken with water or milk per day for 15 days and then once a month to be taken continuously. This will take little time to make you symptomsless- say a week or so.
3. For this heel pain, there might be three reasons because you are specifically mentioning heel pain which later radiates to back of your leg- one that heel might have got something called 'bone spurt'. This you can get detected by simple X XXXXXXX and an Orthopedics doctor will guide you further for that. Second can be neuropathic pain due to long standing diabetes. But is the pain more during night? If so, then for this you will have to take medications which will subside the discomfort. Thirdly, it can be the silicon gel pad which has lost the contour which it should have along with the MCR slippers appropriate to you sole shape. You need to review with your podiatrist when you wear MCR slippers as they tend to lose the complimentary shape or pressure point relaxation over time. May be it's time to get the pair of slippers changed now.
4. Looking at your height and weight, yes, you are overweight. So cutting down your food intake overall from each major meal by 10 to 15 % will help you reduce the weight. Exercise you are doing.

I hope you got the expected clarifications. Do get back for any further query. Take care.

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Dear XXXXXXX,

I took a note of your reports and you have both diabetic neuropathy and vitamin D deficiency.

For Vit D deficiency I have already told you what has to be done. For the neuropathic pain you may take medicine called gabapentin or pregabalin which are both safe and effective. For doses and frequency please contact your doctor or Diabetologist.

Secondly, average of sugars (HbA1c) is really high (for your age we expect it to be maximum 7%). We will have to note down your fasting sugar (as soon as you get up, check on the bed), 2 hour post breakfast, 2 hour post-lunch, 2 hour post-dinner sugars - all measured by home glucometer for at least 3 consecutive days. Any of these sugars showing consistently high numbers will make us decide which sugar lowering medicine we would need to change. But as of now it might be good to reduce your Inj Mixtard dose by 2 units to prevent afternoon hour headache. Discuss with your treating doctor and apply the changes.

You can contact me with your sugar readings taken 4 times a day for 3 days (4-point profile as suggested earlier) and I will be able to give you more advice. If due to your work or so you are not able to follow all 4 points then please take the readings whichever are possible and let me know. I shall accordingly guide you further.

Hope this helps. Let me know if you have other concerns.

Regards

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